Great expectations: our naive optimism about medical care

Great expectations: our naive optimism about medical care

After reading this article by Tammy Hoffmann, A/Prof Clinical Epidemiology, Bond University; NHMRC Research Fellow at The University of Queensland and Chris Del Mar, Professor of Public Health at Bond University, you might feel a great deal more comfortable about being on Watch and Wait:

"Overly optimistic expectations undoubtedly contribute to the ever increasing use of health services and the growing problem of over-diagnosis, where disease labels are given even though the latent disease might not have ever caused symptoms, and over-treatment, where unnecessary treatments given."

There are a few interesting links included in the article, including the reference to the "Choosing Wisely" campaign, from which we recently saw an article about the lack of benefit from CT scans for early stage CLL patients:


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  • This is an interesting and timely discussion paper Neil and actually a subject I've discussed briefly with my own GP.

    Whenever surveys are conducted, it appears that the general public place doctors at the head of the table in terms of trust and authority. It places such a responsibility on GP's particularly to deliver holistic medical care in a consultation that often has a 10/12 min time slot allocation. I firmly believe that a combination of over expectation and expediency leads to a pure problem solving response based on the organic model of medicine. Which is why patients may go in with an intractable social problem and come out clutching a prescription for depression or insomnia.

    The Royal College of General Practitioners has highlighted the need for doctors to address patient problems in physical, psychological and social terms. The most contemporary thinking about the consultation assumes it must be analysed with respect to these three features. It's called the 'triaxial' model I believe but in the present day NHS, I often wonder how realistic it is. The GP/primary care doctor can spend more time inputting computer data than diagnosing and so many patients believe he or she knows best and are unquestioning. But patients expect instant fixes sometimes and can be disappointed if they don't come out clutching a prescription. Hence the over-use of antibiotics and resultant resistance.

    I like the sound of the 'Choosing Wisely' campaign and of medicine delivered more in partnership with patients. They'll always be dinosaurs in the medical profession and unquestioning sheep amongst the general public however. I've actually found that many doctors love to be kept on their toes and they are the only ones I want treatment from! :-)

    As you can see, it's a subject I feel passionately about! Lol


  • Well done Newdawn for talking about this very important subject with your doctor. One of the benefits I'd like our membership to achieve from what they learn on this site, is to be encouraged by their increased CLL related medical knowledge so they'll use it as a foundational basis for a more equal partnership with their medical team. So I found this comment in the article particularly encouraging: "Modern medicine is slowly moving towards a commitment to true partnerships between clinicians and their patients. Realising that people often come to consultations with preconceptions and expectations is a step closer to achieving this."

    It is rather daunting in reading this article to discover how we "have set a halo around medical care", but at least by being aware of this halo effect, we'll be in a better position to make a sounder choice when we are offered different options.


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