Decisions, decisions

Today's world is full of choices, from the most mundane (the number of different types of breakfast cereal on a supermarket shelf?) to the most exciting (holidays designed just for you, not 'off the shelf'). We have been told 'it's good to have options' but I think you can have too much of a good thing and can personally find the constant weighing up tiring.

In medicine too, we have options. For many years 'doctor knew best' and we made decisions on our patient's behalf, with the knowledge we had of the person and their condition. The maxim has changed and now our patients will expect 'no decision about me, without me'. National inpatient surveys have shown around 50% of patients would like to have more knowledge of available treatment options and the potential consequences (particularly adverse effects) before they give their consent. This percentage has remained stable for the last 10 years.

In primary care surveys, approximately 24% of patients would like more involvement in their care and recent papers in the BMJ suggest GPs may be guilty of not making enough effort to include the patient in the decision-making process. Sometimes this may be because we have unconscious bias towards certain options, or maybe lack sufficient knowledge to adequately counsel the patient, or there may be insufficient time within the surgery to carefully go through each option and answer questions. Never fear, for help is at hand.

Several groups have now produced patient decision aids. These are designed to help the patient see the pros and cons of each potential option. Cochrane reviews have validated their efficacy. There are 36 NHS decision aids with a broad range of topics - joint replacements, treatments for MS, depression and breast cancer. The potential harms of breast screening are in the headlines once more and many women may soon be seeking your advice about whether they should attend for their mammogram. Printed, evidence-based assistance may be welcome. The NHS decision aids are quite detailed and lengthy, taking into account what factors are most important to the patient, as well as potential adverse effects. Relative risk is explained simply. Other groups, such as Option Grids and MAGIC, have designed shorter leaflets, designed to be printed out in the surgery and taken home by the patient to digest slowly, over several cups of tea. Patient and GP can then have a focused discussion on what is important to the patient, on their return. All these aids are now available on and more will become available as they are produced.

This month we have also updated our guidance on Feverish illness in children and Schizophrenia (as new NICE guidance has been released), Anaemia of Chronic Disease (BCSH guidance) and Sexually Transmitted Infections (BASHH/RCGP).

For a full list of our updated content this month visit: