Does anyone (apart the closet physicists among you) remember Newton's third law? Roughly translated it's any action has an equal (and opposite) reaction. The clever bit is that it doesn't just apply to colliding objects - it pervades most situations.
Some of these reactions are predictable, some are not. Take the case of sea otters, highlighted in the Sunday Observer recently. These are fantastic creatures, dextrous and playful and they also (apparently) have built-in pouches for their crab-crushing, stone tool. Until recently they were hunted by man. Their demise led to an increase in algae - via the increased number of crabs reducing number of sea slugs, which feed on algae. Algae attack seagrass, where fish like to hide. Fish that are unable to hide are caught. Fewer otters, fewer fish - who'd have predicted that? I have another unpredicted consequence though - how the rise in consumerism has had an impact on the practice of medicine.
Consumerism has risen hugely since the 1950s. There have been some benefits; you could say education and initially even diet and health improved, although not perhaps in the last 20 years. However, things may be a little out of control when you have 36 different types of bottled water (a luxury item) on offer in your local supermarket. A chilling potential endgame for consumerism is seen in David Mitchell's Cloud Atlas. A dystopian, post-apocalyptic future sees cloned fabricants serving self-centred and superficial humans. The fabricant's second rule (a version of the Ten Commandments) is "honour thy consumer".
John Diamond wrote eloquently in 2001 (in the wake of Harold Shipman) expressing how doctors still seem to be viewed by many: "If they don't actually set out to kill you on purpose then they'll do it by accident. It's a view which fits in with our new, consumerist view of healthcare. We don't like doctors because they tell us what to do rather than giving us the choice that consumerism demands we have. If medicine were a truly modern and democratic practice then we wouldn't get a prescription from a GP but a menu of options, with something for every medical taste and pocket, and never mind that few of us have even the most basic knowledge we need to choose between what's on offer." Prescient, given this was several years before 'Choose and book' and 'No decision about me, without me' were embedded in our daily lives.
Choice has pervaded all aspects of the consultation too, starting with who you see and when you are seen. Pre-NHS you paid your weekly contribution and were grateful to see anything with a stethoscope. But, informed choice is great. There can be few who would argue against a person truly understanding all the risks and benefits of a treatment they are signing up for. Although I worry that not all are capable of making those decisions, no matter how well they are explained. Perhaps there is still a place for benevolent paternalism in certain situations? So, the next time you feel aggrieved that your patients are demanding more of you, stop and think: when did I last fill up my Amazon basket? You may also be part of the problem.
This month, to aid our consumer, we have produced new information on dissociative disorders (professional article and patient condition leaflet) and acute kidney injury (professional article and patient condition leaflet.) We have also added first aid content in association with St John Ambulance. Information has also been updated (following NICE guidelines) on anxiety disorders. Our full list of all our updated content is here.