Do we expect too much of our doctors?

March 29, 2017 by mariemcw 1 Comment

Today, Dorset Macmillan Advocacy‘s Coordinator Jen Rimmer considers patient – Doctor communication and how advocacy might help:

Working as a cancer advocates, we witness the communication between patients and their doctors all the time. When that goes well, the outcome is good for everyone involved; but when it doesn’t the effects can be truly distressing.

In her lecture ‘The Right Stuff: How Do We Make Moral Choices?’ Professor Gwen Adshead of Gresham College attempts to examine a central issue in patient doctor communication and it made for interesting listening.

Professor Adshead asks her audience to consider that doctors must consider not only what CAN be but also what SHOULD be done when making decisions about treatment. Previously a good clinical decision was equated with a good ethical one but this is no longer the case.

From a purely clinical perspective the path ahead can seem obvious– she gives the example of a heart failing due to lack of blood – but the complexities of the patient’s own unique personal and social values that inform their wishes should be considered. Things get even more complex when considering the more emotionally challenging aspects of healthcare (i.e. end of life care, decisions to refuse or discontinue treatment) or where an individual’s capacity is compromised.

Gwen Adshead

Although philosophy is taught at medical schools to support our doctors to make the inevitable ethical or moral decisions they will face, Adshead reports that one of the most common complaints aimed at medics is still “that they do not listen to the lived experience of ‘the patient’, or let the patient’s ‘voice’ be present and important”.

But it is reasonable to expect our doctors to be confident to make well informed, ethical decisions in every case? She asks, “whether it is just and fair to expect a group of people who are chosen for cognitive intelligence and intellectual skills in exam passing to become morally superior individuals?”

Is this where advocacy can offer most value? Helping the patient’s voice to be heard also has the secondary effect of supporting the doctor in their clinical role.

Advocates spend time with their partners and gain an understanding of that person beyond their illness. Can we expect a doctor to be able to glean and process enough information to make the best ethical decision for that individual within the 4 walls of their consulting room?

Adshead describes how a person’s decision making processes are affected by the past, the present dilemma and even their views and beliefs about the future. Often this is not obvious to an onlooker or even to the person themselves. Having an independent advocate can help unpick some of this complexity. Discussions take place in a neutral space allowing freedom to explore thoughts and feelings and work out what is right for them.

No matter what our life experience, there will be situations where we find ourselves in uncharted territory and struggling to navigate. As Adshead states, “vulnerability and neediness are not indicators of low status or even disability; they are aspects of a person’s identity that are part of the human transactions that are essential to social life.”

Advocacy recognises this and can offer the support to gain the best outcomes for all involved.

Dr Gwen Adshead is Visiting Gresham Professor of Psychiatry and currently consultant forensic psychiatrist at Ravenswood House. Prior to this post, she worked at Broadmoor Hospital from 1996, first as Consultant Forensic Psychiatrist, and then as a Consultant in Forensic Psychotherapy.

This lecture is part of a series The Right Stuff: Ethics and Moral Psychology and is available online here: https://www.gresham.ac.uk/lectures-and-events/the-right-stuff-how-do-we-make-moral-choices

Jen Rimmer, Dorset Macmillan Advocacy

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