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Patient Choice: nightingale or nightmare?

Peter writes for FHIT as a guest author

I was working with a group that provide call centre services for the NHS Choose and Book system a few weeks back. Casually I enquired: “Do patients exercise choice when asking for health services?”

The person I asked appeared to swell a little and then launched into a bit of a rant:

“Well, strangely enough, a lot of them do not. Most choose the nearest local facility. It is almost universally a myth that people in Kent would choose to go to Aberdeen for an operation. In quite a few cases, they actually find the notion of choice to be an irritation. In fact, just the other day, we had to report the case of a patient who had complained bitterly to the Department of Health about the need to make a choice. As far as she was concerned, she was so concerned about her health that it was just one more hurdle too far to decide whether she wanted to have her care delivered in Milton Keynes, Manchester or Milan!”

So, what's the problem with this I wondered? Surely the skilled call-centre person could head off the complaint by explaining that they could simply opt for the first available local service or let the call centre operator decide for them? How wrong could I be?

On further discussion, it appeared that the call centre staff have no choice but to offer choices. They are simply not allowed to apply common sense to a given situation, and are hidebound by a complex rulebook that prevents them from saying certain words and making certain suggestions. What can we conclude from this?

  • There's no doubt that choice is a good thing when it is important to make a choice.

  • A system based on choice must provide the operators of that system with the flexibility to offer the choice that the patient desires. If the patient does not want to make a choice, then this is a choice.

Peter Cook is the author of “Sex, Leadership and Rock 'n' Roll - Leadership Lessons from the Academy of Rock”it explores Leadership through the metaphor of music. Top Business Guru Tom Peters recently said of it:

“None would doubt that we live in a Rock 'n' Roll Age -- so what makes more sense than a brilliant, original, rockin' Rock 'n' Roll model of business management and leadership? Sex, Leadership and Rock 'n' Roll is a marvellous book, which closes the door on the tidy, hierarchical, know-your-place 'Orchestral Age' and ushers in a new, creative era of challenge and change. Hooray!”


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Having to make choices is not pleasant if you don't feel you're competent to assess the consequences of your decision.

There's a convincing interpretation of the whole choice thing which is that the policy makers are stuck into a mindset that treating people as customers is the best way of treating them. But customers of the NHS are often sick, feel that things are happening to them they can't control, and are worried and looking for expert help. They're not enjoying themselves out shopping.

Choice is nice sometimes: my son broke his arm, I went to hospital in the ambulance and the paramedics asked which hospital - so I chose one that I could get to more easily rather than their default. That was good.

But if I have a cancer scare, and I have to make a decision as to where to go for the next stage of my 'patient journey' I would want someone to tell me which place was best. And who better than my GP? I would hate to be offered a choice without expert advice as to which option to take because I would feel incompetent to assess the alternatives, and worry that my wrong decision could result in something awful.

Guess a lot of health care is in between these two points.

"The agony of choice" - who ever assumed that offering choice made things better. To choose you need to make a decision, to decice you need accurate data AND an ability to interpret it correctly. What happens if you don't have one the other or both? Is this\ better than not being offered a choice? H'mmm ...

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