Working with doctors Working for patients

 

Introduction

Mrs Ford has suffered from high blood pressure for some years, and is developing heart failure, the symptoms of which are affecting her ability to work and her quality of life. She is unhappy with the treatment that she has received on the NHS and has self-referred to Dr Liebowitz, a private consultant cardiologist.

Dr Liebowitz has examined Mrs Ford and carried out tests to establish the options for her care. There are several different treatments available but Dr Liebowitz believes that the one most likely to be of overall benefit to Mrs Ford is an ACE inhibitor, which will help both her high blood pressure and heart failure. Dr Liebowitz recommends a drug which is newly on the market. He is aware that ACE inhibitors can cause a range of adverse reactions, including low blood pressure, elevated potassium leading to potentially fatal abnormal heart rhythms and damage to the kidneys - but has not yet explained this to Mrs Ford.

Dr Liebowitz

Dr Liebowitz

So, in a nutshell, that's how I'd suggest we proceed. At the very least we should be able to stabilise your condition and slow the deterioration, and many patients who are on this type of drug do show signs of real improvement after just a short while.

Mrs Ford

Mrs Ford

It sounds a little too good to be true. I've heard promises like that before. Are you sure it will work? What about complications?

Dr Liebowitz

Dr Liebowitz

Well, there is always a slight risk of any treatment not working, or causing side effects. Even a simple aspirin can be harmful in certain circumstances. But even though this is quite a new version, ACE inhibitors have been around for a while, and there is a fair amount of information about how they work and the sorts of things that can go wrong. Obviously we'd keep you under review and if there are any problems we can easily take you off it and have a re-think.

Mrs Ford

Mrs Ford

I'm just not that sure, doctor. What do you think? Would you be happy to take this medication if you were in my position?

What should the doctor do...? (Select A,B or C)

A

Firmly steer Mrs Ford towards accepting the treatment he has recommended?

B

Explain to Mrs Ford that he cannot make the decision for her but is there to help and advise her?

C

Explain why, in his professional view, treatment with the new ACE inhibitor offers the best possibility of improving Mrs Ford's condition?

Dr Liebowitz

See what the doctor did

Dr Liebovitz told Mrs Ford that, if he were in her position, he would try the recommended treatment because it offered the best chance of improving her condition and controlling and reducing her symptoms. He reiterated that no treatment is entirely without risk, and emphasised that she needed to take into consideration the small possibility of an adverse reaction, but he didn't go into any detail about the potential side effects of taking the new medication.

References

11. You must try to make sure the information you share with patients about the options is objective. You should be aware of how your own preferences might influence the advice you give and the language you use. When recommending an option for treatment or care to a patient you must explain your reasons for doing so, and share information about reasonable alternatives, including the option to take no action. You must not put pressure on a patient to accept your advice.

23. You should usually include the following information when discussing benefits and harms.

a. Recognised risks of harm that you believe anyone in the patient's position would want to know. You'll know these already from your professional knowledge and experience.
b. The effect of the patient's individual clinical circumstances on the probability of a benefit or harm occurring. If you know the patient's medical history, you'll know some of what you need to share already, but the dialogue could reveal more.
c. Risks of harm and potential benefits that the patient would consider significant for any reason. These will be revealed during your discussion with the patient about what matters to them.
d. Any risk of serious harm, however unlikely it is to occur.
e. Expected harms, including common side effects and what to do if they occur.

(Decision making and consent, paragraphs 11 and 23)