A doctor working in Wales has had restrictions placed on her practice by the General Medical Council (GMC) despite the vociferous support of people who have benefited from the care that she provided.
The GMC changed the guidance determining the duties of all doctors working in the United Kingdom in 2006. Since then doctors have had a duty to take the priorities of their patients into account at all times. The draft guidance had a subtly different emphasis instructing doctors to give priority to their patients’ preferences. I am sure that I was not the only doctor who commented to the GMC that that wording could make our decision making difficult if a patient’s priorities were based on a non-scientific world view.
Those who attribute their symptoms to a process, biological, chemical or physiological, for which there is no scientific basis or their friend’s cure to a treatment that has been shown not to work by research trials continue to present a challenge in the consultation. However, I continue to learn that not everything that I believe, trying to be as scientific and up to date as possible, is true. Examples include:
• Careful research by Dr TJ Dyke into the cholera epidemics in Merthyr Tydfil in the Nineteenth Century to show that the new theory of Dr John Snow about cholera transmission and water was wrong,
• The Nobel Prize for medicine and physiology in 1949 was awarded to the inventor of lobotomy as a treatment for mental illness,
• Hospital bed rest for ten days was the recommended treatment for a heart attack until the late 1970’s,
• I have spent the last five years putting people with diabetes or high blood pressure onto aspirin thinking that it will reduce the risks of them experiencing heart disease or stroke. Now I am taking them all off the drug since the consensus from research is that it causes such people more harm than good,
• Research published in 2007 demonstrated that a tablet given to many people with diabetes could double the risk that they might have a heart attack. Experts I spoke to at the time disagreed with the research findings and continued to use the drug. A recent series of articles document how the information was handled and why there are still patients being prescribed the medication.
• An essay was published in 2007 suggesting that “women will not change the date of their death certificate by taking a statin”. This related to women who had not had a heart attack or a stroke since there is research evidence to indicate that they may benefit from taking the commonly prescribed cholesterol-lowering medications. The essayist’s view has yet to be rebutted by the pharmaceutical industry and an analysis published in 2009 confirmed it when you looked in the very small print of one large table of results. I no longer offer such tablets routinely before assessing the personal risk for each woman and sharing my uncertainties about the science with her. She can then make what I hope is a more informed choice about whether or not to take the medication.
I am very conscious that people in glass houses should not throw stones and that the log in my eye is likely to be bigger than the splinter in yours. There is an interesting rabbinical insight: when your splinter makes me very angry, it is because my log is from the same tree.
