The General Medical Council (GMC) is the governing body for doctors in the UK (like me). The GMC publishes rules and regulations on how we doctors go about our business. Of course, the real aim of having such guidance is to ensure that individuals get a certain standard of medical care. Perhaps with a patient focus in mind, the GMC has recently published guidance on what individuals can expect from their doctors. You can read the guidance here.
One of the broad sections of this guidance is entitled ‘Doctors must treat patients as individuals’. I actually think this is an area which we doctors struggle with quite often. Certainly, I quite often hear complaints from patients who feel their regular doctor (usually their general practitioner/family physician) does not treat them as an individual. One way this quite commonly manifests is when a doctor recommends a treatment, and a patient expresses doubts about it and/or whether it’s right for them.
A classic example of this concerns the recommendation to take a statin (cholesterol-lowering drug). This may be suggested by a doctor, but I think increasingly patients are pushing back against this advice due to increasing recognition of the limited benefits and potential harms of this treatment. Many patients I have spoken to have felt ‘fobbed off’ by their doctors when they’ve raised legitimate questions and concerns about statins.
Not uncommonly, a doctor will suggest a patient is being reckless or even stupid for not taking statins. Dismissal of concerns about side effects as being ‘very rare’ (when they’re not) I think is common too. From time to time, I meet people who have felt ‘forced’ to take a statin. Some are on a statin and are fearful to stop in case of how their doctor may react.
I do not suggest people reject their doctor’s suggestions out-of-hand. But I do believe that coercion and fear do not make great bases for medical management decisions. As I sometimes feel the need to remind people, no-one can force them to take a medication (unless of course someone has been restrained and is forcibly medicated against their will – that’s perhaps a topic for another day).
The good news is that the GMC has acknowledged that doctors should answer patients’ questions and concerns properly. And that whether a patient takes up the offer of treatment is up to the patient. Here’s the relevant wording from the GMC guidance:
I do not want to make trouble between patients and their doctors (there’s already way too much of that going on already, in my opinion). However, I have to say I find some doctor behaviour I’ve had relayed to me is shocking and unacceptable. A big part of the problem, it seems to me, is simply not respecting a patient’s views and wishes. Should this happen to you, and if you’re in the UK, then you are quite within your rights to remind the doctor of their duty of care to you as set down by their governing body.
I don’t know what the situation is in other countries. However, even if treating patients as individuals and honouring them is not enshrined in professional guidelines, I do think it’s the least patients can expect. These common courtesies make for good relationships and good medicine, in my opinion.
After reading the various “Cholesterol Con” books I decided that my supposedly “high cholestrol” level (anywhere from 5.4 to 6.5) was, for me , a non issue.
However, it was suggested to me that, if I wanted to stop having the Doctors trying to pressure me into taking Statins ( I was once tag teamed by three Doctors) I should write a letter to my surgery stating that I was aware of the “risks” of having high cholesterol but I would, none the less, request that all further efforts to have me take statins be discontinued.
I did write the said letter.
My previous GP told me the “I wasn’t entitled to know where my liver was” Gobsmacked is not a serious enough word..
Current one treats me mostly like a grown-up, but if you really want to be handled badly, perm any three from Fat, Female, Fair, and Over Forty.. (I’m a thin diabetic, so fall alongside all the stools..)
Oh, and I’ve taken to refusing BP measurements in-surgery, and particularly in the hospital Outpatients departments, as they WILL NOT allow a 5-minute sit-down, and I know that one “high” reading will follow me around for years..
HH
Thank you for debating this issue. Considering a comment by a doctor can amount to a hex, it is vital that mutual respect be given. While my blood tests show that I am clearly anaemic, my (female) doctor said that this was “perfectly normal in a menstruating woman”. (Why have the parameters then?).
Consultants are the worst. It is just not acceptable to question their pronouncements (in their opinion). It is this kind of behaviour and approach that made me lose all respect for the medical profession. It is now only reserved for specific individuals such as yourself as they need to prove themselves to me first.
When I was teenager and just embarking on my long career as a patient with multiple medical conditions, I used to wonder how old I would have to be before health service staff ceased to patronise me, condescend to me, or try to bamboozle, hector, coerce and insult me. Thirty years on, it turns out the answer is: never!
Some doctors do listen to your questions and appear to be understanding and then they fob you off, oh very nicely but it amounts to a pat on the head and treatment you are not sure you want ……….it seems an awful lot of medical people think that because they have studied for years it some how entitles them to dictate what they learnt at med school as though it were the only way to do things ……….a lot of medical wisdom has been lost due to the focus on the drug solution to everything seems some doctors forget why they became doctors in the first place..I always thought it was because they loved people and wanted to help them stay well …seems not
Across the pond in the USA, the situation isn’t much better. I know more people who are afraid of their doctor than I know people who genuinely like them. And I can understand. As someone who’s been ignored, bullied, and pressured to do things I didn’t want to by doctors through most of my life, I’ve quite honestly lost respect for most of them. No offense, Dr. Briffa; I know there are good docs out there, but the ones I’ve had experience with in person didn’t seem to care much about my well-being.
My family practioner suggested a statin because I am T2 diabetic, even though my cholesterol was (and is) normal. I declined, and it was three years before he gave up. Even his assistant brought it up, so it must have been written on my chart!
Two weeks ago I went for a recommended blood glucose test. I said I did not want the cholesterol / lipid done.
The PA came to me and told me that I should leave and find another physician if I was going to be non-compliant. Wow! This was a young man with eight years experience.
He did finally agree to do just the blood glucose.
It is hard here in the US to find an MD that will take Medicare patients. Sad!!
Great article.
GP’s are very guilty of dismissing people who ask lots of questions and who want to be informed about the whys and what fors of their personal situation.
I love your blog, keep up the great work.
Best wishes,
Richard
Another US citizen here. I’ve completely given up on allopathic doctors in my health plan (Kaiser). The GPs/internists are not permitted to be anything more than robots on a patient consulation schedule. They refuse to engage in discussions about any relevant research I bring to their attention that contradicts their obsolete medical dogma, and they refuse to even perform diagnostic tests I suggest (LDL-P and salivary cortisol). I go to them now only for acute and severe medical problems.
For everything else, I’m consulting with an ND (naturopathic doctor) who loves that I do a bit of research and engages me as a true health consultant. I pay heavily out of pocket for this, but at least I get medical care based on current science and focused on causes rather than symptom management based on discredited health paradigms with drugs.