PATERNALISM IN HEALTH CARE.

[Cateran]

We are frequently given to understand that our GP knows best about our treatment. He or she acts therefore from a position of medical authority. At times and with certain medical issues our patient autonomy is overridden or ignored or because it is expedient. So, how much autonomy do we have as a patient in a practice or in a hospital or clinic? Or rather how much autonomy are we entitled to expect from the clinician?

Are guidelines genuinely patient friendly or drawn up by experts without patient input? Is medical consultation something of a sham?

I would welcome your input into this matter of medical paternalism.

[Katinka46]

Hello Cateran , I have spotted a few of your posts but I have been woefully neglectful about the forum because of a somewhat hectic life at home at the moment. Two things: I have written up my case, very long but it has been read by over fifty members here. It might be of interest to you as we have similar ideas about health care. If you are interested PM me and I will give you my email address.

Secondly: when I saw one of my consultants in June he said that they had recently had a departmental discussion about what patients want, and it may not be what doctors want. So I couldn’t resist writing my own list of what patients want. My consultants thought it was so good that they circulated it all the lung doctors in the Leeds hospitals.... Yikes...

I had thought of posting it here, your post has given me the necessary nudge.

Kate x

[Hidden in reply to Katinka46]

Please do post it.

[HungryHufflepuff in reply to Katinka46]

I second that. 🦓

[CDPO16 in reply to Katinka46]

Yes, please post it.

[Hidden in reply to Katinka46]

So where is it? One nudge not enough? Nudge, nudge, 😉😉 ,know what I mean. xx

[Katinka46 in reply to Hidden]

Oi.... I am right in the middle of preparing the evening meal. Then I have to drive my son’s car 10miles to the station so that he can drive it home (good practice: dark, rain and rush hour). Then get the food on the table. Eat it in a civilised manner. By which time I am seriously jiggered. It will have to wait until tomorrow morning. And only after the reverse driving trip. Slave-driver...

Love from a Somewhat ground-down Kate and neglected Zebra...

Xxx 👵🏻🦓🍵☕️🥖

[Hidden in reply to Katinka46]

Oh dear you are busy. I didn't mean to put pressure on you, Kate, it was just your use of the word 'nudge' set my mind racing off to that Monty Python sketch. All part of my increasing nuttiness I think. Now I've intruded in Mr.Cateran's serious tread.😦😘

[Katinka46 in reply to Hidden]

Nudge away. I can take it. It’s on the list for tomorrow. K xxx

[Cateran in reply to Katinka46]

Hi Katinka, Could you possibly precis your letter to the doctors for me/? I would prefer a synopsis of sorts here in this thread, as I look forward to reading your suggestions circulated to physicians and we could all get your opinions here on HU.

Kind Regards,

Cateran.

[Katinka46 in reply to Cateran]

I was just about to post 'What Patients Want' on here and also reply to your email.

K

[RufusRuffcut123 in reply to Katinka46]

Please post!

[Margaret_craft in reply to Katinka46]

Please post it Kate. It will be very interesting to know. Xx

[O2Trees]

Great post Cateran. Im always banging on about the need to be proactive and work in partnership with our medics. Some are happy with that - the good ones - while others are defensive. We are the experts in how we feel and we often know more about the conditions we live with than doctors do - especially as some are woefully ignorant.

In general as older people (well I am!) we live in a far too deferential culture where professionals like doctors are treated as gods. "Mustn't trouble the doctor!" Bullsh*t!!!

If we need help then we should make sure we get it, in the way we need it.

So tonight's rant over. Night all

[RufusRuffcut123 in reply to O2Trees]

Exactly

[Ergendl]

Yes, I often experience paternalism from doctors at all levels. I usually passively resist them by demonstrating I know what they're talking about and can discuss the alternatives before they mention them. If possible, I then cross them off the list of doctors I am willing to see. Paternalistic doctors (and I'm always right nurses) have caused my body a lot of damage in the past.

[katieoxo60]

Hi Cateran, love the way you put it about doctor knows best issue. from the patients point of veiw we have, healthwatch , surgery patient participation programs, pals, and some larger hospitals have patient participation panels( hard to get on due to the need for references) However these only seem to deal with non clinical issues or fill in forms with the details, just like the complaints service. So sadly to spite moves forward we still have no redress if the doctor/consultant is wrong or has unintentionally done you harm other than the law channel . Oh and recently I found that GPs are still vetted by GPs and obviously no GP is going to be advised to admit default, and apparently anyone with a mental health issue is presumed to be incapable of understanding their own health needs & when something physical is wrong with their body. Second opinions tend to follow the same lines the first doctor cannot possibly be wrong. Always remember Gps are your gateway to best treatment supposedly, however many of them don't have specialist knowledge hence the reason we find it very difficult to challenge when something goes wrong. Incorrect treatment due to poor diagnosis could be constituted as assault so doctors would be well advised to listen to their patient and ask the right questions to establish what the problem is which is what they are supposed to be there for not to prevent you getting treatment if it is necessary or a diagnosis from someone more knowledgable in respect of your illness, side effects are supposed to be weighed against benefits following discussion with the patient. Refusing what the doctor feels is best often leaves you with no treatment however, which again is wrong to my way of thinking. Sorry to go on so much but there are many sides to this issue and most of them are negative not positive. Actions speak louder than words and most patients just say thats fine Doctor until things go drastically wrong but how far does one take respect over need for care.

[O2Trees in reply to katieoxo60]

Great reply

[lorianxiety in reply to katieoxo60]

Hi Katieoxo your account of Gp s,reaction to mental health is in my opinion sadly true-and I had the misfortune to have to deal with such as my M/health was suffering tremendously last year when I was forced to transition from previos practise. Apparently,Gps or the ones ive dealt with have very little knowledge or understanding of M/health-------something which is too time-consuming for them to care and so give you a prscription for an anti-depressant.In this day and age ,its detrimental that ones mental state is just as important ,since they gohand in hand...wth physical condition....I feel very strongly about this having had and still do ,issues throughout my life......its something I care passionately about ,and reaching the ageof 70+i feel I have sufficient authority to air my feelings ,which wasn't encouraged and my mental health didn't improve until much later this year and I still haven't got any therapy

[katieoxo60 in reply to lorianxiety]

Hello, did you watch TV last night about mental health care for over 65s . The facts are horrendous. Plus many of us do not need a doctor we need talk, company, support as the show displayed. I Understand your sentiments, I had my last major breakdown in the 80s but have spent all my life since then being penalised by the medics. When I was labled as paranoid in the 90s I stopped mentioning my mental health and have had no doctor in put since in that respect including when my late husband died of cancer and no support was available for my emotional stress, does not mean I have no feelings that don't effect my physical health just like you say. But there seems very little we can do , even for ambulances mental health is not often considered as a need but regulations say it should be. Health problems cannot be simply defined by what norm tests say or text book examples we are all different as are our reactions, pain is another example of how different everyone is. Please keep airing your feelings true mental health problems are hard to define, and hamper your ability to lead a normal interactive life like others. Hope you begin to recover more as we get nearer to the end of the year. Oh sorry I had a reactive major depression due to trauma in my family.I needed tablets and months of psychiatry & very little contact with the outside world but I still can recall how horrible those months were and how my life has suffered because of future mis diagnosis & difficulty with obtaining reasonable employment. So I admire anyone who wishes to change peoples image of mental health issues. Have a nice day

[Cateran in reply to katieoxo60]

katieoxo60, you couldn't be more right about mental health and the NHS. With doctors' disregard for patients' emotional lives and well-being then patients might as well be the "Disappeared Ones" in health care. This stance is all part of the medical paternalism which dominates the health care system in many countries. Psychiatry is especially the domain of so-called "specialists" who always know best what is good for the patient because of their "special skills" in reading us as if we were a book which only they can open. The current move to centralise mental health facilities is part of this paternalistic view of people, who may as well be cattle for all that health economists care. It simply won't do.

[katieoxo60 in reply to Cateran]

You seem to have the same picture of mental health care /or not as the patients who use it see it. Its a care less service I guess because many see it as incurable. However it is treatable & manageable in many cases.

[Cateran in reply to katieoxo60]

yes Katie, I second 02trees' congratulations to this posting. it is about GP behaviour which expresses an attitude of superiority and medical authority, as if this were to be taken for granted by doctors. We patients are expected to accept their value judgements as if these were genuinely knowledge-based, whereas you point out correctly that this is not necessarily the case. Various guidelines and quality statements are supposed to reflect patient autonomy and shared decision-making. Lip service is paid to the input of the non-clinician, the patient expert such as with bronchiectasis but in my experience that is far from the case. Consultation with the patient only seems to go so far and no more. The paternalism in this is very selective in that not only is it the superiority of expert knowledge and opinion but decisions ought to be made by the physician and no other on the strength of this insider wisdom.

I call this assumption an act of discrimination against the patient on the basis of poor access to clinical knowledge, almost like a word game wherein if you do not follow the rules of this game you are penalised. The analogy might be like London taxi drivers who spend years gaining the "knowledge" of city streets and byways before they graduate to plying for hire; the same is for doctors and graduates in medicine, who are soon trained in a form of masonic inner craft and secrets of public medicine, with always the authority that comes along to lord it over the patient, and I might add nurses too in the equation.

Paternalism is interwoven with hierarchy in the NHS, reflected in the pay scales and grades. Utilising paternalism becomes not only necessary but obligatory.

[katieoxo60 in reply to Cateran]

Good morning Cateran, until you said the word Paternalism I never realised how much it does sum up the workings of the NHS from top to bottom, but I have always felt it was the only authority that was not held responsible for its action but that is not so, other authorities work in the same way to avoid being answerable. I thought the new approach for all national bodies or government financed departments was one of transparency not least the NHS 's committment to patients care.I am not complaining but why make a committment that they know they cannot meet and waste masses of money on something that will never happen because they do not have the time, knowledge or staff to carry it out. Its a bit like burying your head in the sand and hoping it will go away, rather than confronting the issue and maybe resolving the matter.

[Cateran in reply to katieoxo60]

Good morning katieoxo. Yes, Paternalism is catching as a cover for gendered labour in health care, as with many other professions, as you point out. Nurses are as much exploited for their class roles in hospitals being subject to a a command stratification between doctors who represent medicine and mere nurses who represent caring (of) sorts. It is the traditional care and cure dichotomy, where doctors can cure you and nurses, predominantly women, care for you and of you. Nurses become a sort of proletariat in hospitals, some highly skilled others less so.

This rigid stratification however is being eroded and broken down, when the prevalence of chronic disease of the elderly has altered things. Paternalism now becomes crucially important in securing the class position in medicine, albeit rather a hollow ascendancy, in that long-term care swings the pendulum away from men who cure you (at least mostly men) towards women in the ward and the opposite of paternalism, which is matriarchy, a much deeper and profound force in health care.

Ironically, there is no "cure" for chronic illness, only good care. Nurses can give that if they are allowed to, which is precisely the question. From this statement you will see that I am an ardent feminist...

[katieoxo60]

Hi again Cateran, yes in medicine there is a lot of type cast roles, i.e more male doctors in general and female being used for nursing more than male. I am a female who lives alone and associates with more all female gender than male but would not call myself a feminist even though I associate with a lot of ardent feminists. I beleive in equality but feel we all have a part to play and no one should be presumed not able due to gender including disabled. In the NHS , having also worked for them I beleive they should work more as a team using the skills of all and doctors should be more integrated with their staff as well as patients. We are all human with faults &abilities.......