“And ye shall know the truth, and the truth shall make you free.”
I listened to a BBC Radio 4 programme on 26 November 2018. It was part of a series called 'Thought Cages", an episode called "Be successful or be loved? The NHS Agenda". It's message was amazing. Rory Sutherland, the presenter, began by asking what I thought was a silly question.
- Do people visit their doctor in order to get well?
- Or do they go in order to check that someone cares about them?
This motivation, the programme said, is hidden, buried deep inside us - it was called the 'Elephant in the brain'. We do not care so much how we are treated, just that we are treated. We are not looking for the best medicine, the medicine that provides the best outcome, the best life expectancy. How we are treated, medically, is less important than how we are treated, socially. It is not the quality of the treatment we care about, more the process of receiving it.
To begin with I was sceptical about the whole idea. Perhaps I did not want to believe it. After all, I spend a lot of my time trying to convince people the conventional medicine provides us with poor patient outcomes, that pharmaceutical drugs and vaccines are both ineffective and unsafe. But then, Sutherland gave this stunning example of the process at work.
Harold Shipman was a doctor convicted of killing 15 patients in 2000, and there seems little doubt that he killed many more. Yet his patients loved him. He treated them respectfully, he was friendly, and he was prepared to visit them at home. In the end it was not his patients that realised what he was doing, it was a taxi driver who noticed that he was losing a lot of patients. So he went to the police. Apparently, many of Shipman's patients did not change their doctor, they changed their taxi driver!
One contributor gave another example, a piece of research undertaken with patients who were about to undergo heart surgery. Would patients be prepared to pay a small amount of money to find out which surgeon had the lowest mortality rate. The study concluded that people were not interested in this. Very few agreed to pay. So the conclusion was that it is not medical competence we care about. The treatment we are given might kill us - but as long as we feel the doctor cares, and is doing the best he can, we are content.
People want to trust their doctor, and forget about everything else. We hand over responsibility. The outcome of the treatment is not important. There is research that shows most patients do not want to know about divergences in health care standards. Easy access to treatment, amenably offered, is more important. Do we like the doctor, do we warm to him or her.
It was, the programme suggested, better for the surgeon to be friendly than competent!
Unfriendly doctors lose patients, they will go elsewhere, presumably to other doctors where they receive a warmer welcome, a more positive response. The NHS is indeed measuring patient experience, and as a result producing league tables. These tables do not concern patient outcomes but the social experience of the patient. It is more about being treated courteously, a friendly staff, keeping waiting times as brief as possible.
In particular, research has demonstrated that people don't like waiting, they hate the uncertainty, the doubt whether anyone is ever going to see them. One strategy, adopted by airports apparently, is that we are now made to walk a couple of miles to the luggage carousel so that we do not have to wait! Hence the importance the NHS gives to waiting lists.
So, although conventional medicine is ineffective and unsafe, this is not how most people are judging it. The programme discussed whether patients were looking for expensive medicine (a medicine that is effectively bankrupting the UK's NHS), or a surgery waiting room with snazzy colour schemes, up-to-date magazines, and comfortable sofa’s. One research study asked patients whether they thought that ALL drugs should be available to them, regardless of cost, and even if they did not work. They did!
So presumably many patients also wanted to be given pharmaceutical drugs even if they caused disease, even if they killed patients. Patients, the programme said, show little interest in patient outcomes, little interest in mortality.
Patients were looking for reassurance. This also struck a bell for me. Most people, when they feel unwell, want to get better, but most importantly they want to know what is wrong with them. They want a diagnosis. I have often noticed this. "I feel so much better now that I have a diagnosis, now I know what is wrong with me". When it is pointed out that a diagnosis does not make them better, they still need safe and effective treatment, that is NOT what is important. Even if the diagnosis is that the patient has only 6 months to live it is reassuring. At least they know!
So forget safe treatment. Forget the dangers of treatment. Forget the ineffectiveness of treatment. As long as the experience of accessing treatment is good, as long as there is a good explanation, as long as access treatment is easy - that is what matters.
The programme ended with a remark that while £billions were being spent on health there appears to be little or no improvement in patient outcomes, in life expectancy. One contributor said that if USA health spending (the highest in the world) could be halved, and it would make little real difference to the nation's health.
The programme explained for me a little more about the irrationality of how we provide health services, something I have written about in depth before. If homeopathy is superior to conventional, drug-based medicine in terms of effectiveness, safety, cost and patient outcome it makes little difference. We have to understand that this is not necessarily what many people are looking for.
Yet I am not sure that this is the whole story. We are tricked into thinking we do not have to worry about the safety and effectiveness of conventional medicine.
- Governments promise us 'the best medicine available'.
- The conventional medical establishment tell us that they are winning the battle against disease.
- Our doctors, in the main, are very friendly and kind, and we do believe that are trying to do the best for us, and certainly would not harm us.
- The mainstream media plays its role in reinforcing, and failing to question all these messages.
- Television portrayals of conventional medicine frequently support these messages (something I will be blogging about very soon - have you noticed how many medical soap operas there are on television these days?)
So we trust our doctors and the medicine they give us. It is time for everyone to wise up. Yet to wise up means we have to start questioning everything we have been told about health throughout our lives. And that is not easy. But we need to do it before conventional medicine makes us sick, and sicker, and then kills us.