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When patient choice becomes a decision-making dilemma

Not everyone is comfortable with a ‘choose your own’ approach to care, says Jane Bates
Image of man contemplating, with question marks around him

Not everyone is comfortable with a choose your own approach to care, says Jane Bates

Why didnt they warn me about the custard creams? said a friend.

He had just had keyhole surgery and on the recovery ward they gave him tea and biscuits, offering a selection.

Whats wrong with custard creams? I asked. Theyve always been rather a middling kind of biscuit to me. Good for dunking.

Well, when youve had that stuff to dry out your mouth, the custard creams get stuck round your teeth, he said. I couldnt speak for a full ten minutes. I could hardly breathe. Thought I was going to die. Rich tea would have been so much better.

I wondered if this might develop into a national scandal #custardgate, perhaps. Takes the biscuit, I agreed, but it all boils down to

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Not everyone is comfortable with a ‘choose your own’ approach to care, says Jane Bates

Image of man contemplating, with question marks around him
Picture: iStock

‘Why didn’t they warn me about the custard creams?’ said a friend.

He had just had keyhole surgery and on the recovery ward they gave him tea and biscuits, offering a selection.

‘What’s wrong with custard creams?’ I asked. They’ve always been rather a middling kind of biscuit to me. Good for dunking.

‘Well, when you’ve had that stuff to dry out your mouth, the custard creams get stuck round your teeth,’ he said. ‘I couldn’t speak for a full ten minutes. I could hardly breathe. Thought I was going to die. Rich tea would have been so much better.’

I wondered if this might develop into a national scandal – #custardgate, perhaps. ‘Takes the biscuit,’ I agreed, ‘but it all boils down to patient choice.’

‘Not informed choice,’ he replied.

Healthcare in the age of patient choice

This particular friend has led a charmed life health-wise. Apart from the usual childhood illnesses, he has reached his eighth decade without ailment or accident, and until recently had no idea who his family doctor was.

Now he goes to the surgery so often they have their own WhatsApp group. Age has taken its toll and he has been plunged up to the eyeballs into the alien world of the NHS.

Patient choice, whether regarding baked confectionary or medication, he finds bewildering.

‘Can’t they just tell me what to do? Give me a bit of guidance? “Go for the digestives” – something like that?’

Patient choice has become the norm, but it wasn’t always the case. In my day, as we turned up at the patient’s bedside with nine yards of tubing and some KY jelly, we were schooled to tell the patient what we were going to do. Not ask them, tell them.

When patient meals meant fish on a Friday

They took it on the chin. Do what you have to do, they said. Most of them had been through a war, maybe two, and were used to keeping calm and carrying on, even when a trembling rookie nurse was pointing something sharp in their direction.

At mealtimes, there was never any choice. Patients’ food was dished up and plonked in front of them with no alternative on offer.

Don’t like mutton stew? Then you had to go without. When fish was served on a Friday, non-fish-eaters were doomed to a dollop of mushy peas and a few cold chips. A la carte was not on the menu. 

A generational divide on clinical decisions

In clinical matters there is a generational divide, in the matter of choice. Our older folk grew up with authoritarian medics who gave them little say in their treatment, and there are still some people who are comfortable with that.

‘Why is he asking me?’ I heard one patient say. ‘He gets paid to make decisions, I don’t.’

There’s a lot in that – someone to blame if it all goes wrong.

My friend is still coming to terms with this new dimension in his life; making difficult decisions that will affect his well-being. It’s a steep learning curve.

Next time, he says, he might try the shortbread.


Jane Bates, retired nurseJane Bates is a retired nurse

 

 

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