25 January 2016

The choice is yours

After my latest experience with the medical profession, I was left pondering the question 'Are patients sometimes given too much freedom of choice?' 

One evening early last month, I started having heart palpitations at least two to three times a minute. Somewhat panicked, I called my doctor's surgery the next morning, and they invited me in for an ECG that afternoon. As soon as I lay down, however, the palpitations eased, so I wasn't surprised when the doctor later told me the test results were normal.

After I'd described my experiences of the last 18 hours, which seemed to contradict these findings, he said, 'Well, if it's troubling you, we can run some blood tests and possibly a 24-hour monitor. What would you like to do?'

I was bemused by the question. Now that I'd explained the true extent of the problem, why was he was putting the decision in my hands? This seemed, to me, to be a genuine issue; I wanted to know what was causing it, why didn't he? 

I opted for the blood tests and by the time these came around I'd concluded - from my hours of online research - that I was experiencing ectopic beats: premature or extra beats. While these can be completely innocuous, and are often idiopathic, ie with no certain cause, they can also be the result of a serious underlying condition.

If I'd been more easily persuaded by my doctor's assurances, or had lacked the confidence to challenge them, I would surely be running the risk of something significant being missed?

The blood test results were all fine and although the doctor noted that the ECG had picked up some ectopic beats, he told me this was normal. I reiterated that these were occurring far more frequently than recorded and requested the 24-hour monitoring.

Image courtesy of Stuart Miles/
Incidentally, he didn't elaborate on the term 'ectopic beats', which is another issue: patients are not always given an explanation of their diagnosis, or the treatment offered, and may be too confused, upset or timid to request one. 

I had the same experience two years ago, when my gynaecologist briefly outlined three treatment options before saying 'Go away and look into them, then give my office a call and let me know what you'd like to do.' While I appreciate that he may not have had time to go into the pros and cons of each one, a little more of a steer would have been welcome. 

Things have obviously improved on days gone by, when doctors would brook no discussion and their word was law, but any patient-led decision does need to be informed by clear, and expert, guidance.

If this 'light touch' approach is applied to those with mental health disorders, it could prove particularly detrimental. 

How, for example, is somebody with anxiety or compulsive thoughts supposed to handle researching their situation and deciding on treatment? The internet is full of conflicting advice and scare stories that are fuel to the fire of such conditions. And I doubt somebody with depression is going to have sufficient motivation to engage in this way.

Is this increase in patient choice a growing trend or are my experiences untypical? If it is a trend, is this degree of choice always a good thing? I'd be interested to hear your thoughts.

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PS The heart monitoring starts tomorrow - fortunately the palpitations have now subsided considerably, so I'm hoping for an 'innocuous' or 'idiopathic' outcome.

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