THE BLOG

The Three Rs of Healthcare: Responsibility, Risk and Resources

11/05/2015 10:47 BST | Updated 10/05/2016 10:59 BST

Our behaviour as patients is usually entirely logical and often the result of scare-stories and simplistic advice from politicians and in the press. One problem we face is that everyone seems to be an expert in when one should seek medical attention, but far fewer are willing to say when that might not be necessary. Indeed, just because attending A&E is judged to be inappropriate, that doesn't necessarily mean that consulting a GP is more appropriate. Blaming patients would be completely inappropriate.

Ask not what your country can do for you

A very large number of concerns that people bring to their GP require no medical treatment at all. Actually, being able to reassure people is one of the most satisfying aspects of being a GP. However, there are growing demands on the NHS from an ageing population with more long term conditions and expectations that medicine should be increasingly preventative - for example prescribing statins, when actually a healthy lifestyle is more important. Added to which, there is a growing shortage of GPs, for which no political party has as yet proposed a credible solution.

Of professionals, a good GP is second to none in making these calls (without resorting to extensive and potentially misleading tests every time) and "safety-netting" for the rare event when they are wrong. With the best skills in the world, we won't get it right every time. Indeed, even (arguably especially) if we had unlimited resources (!) and were to investigate every patient extensively, we would not get it right every time. Tests carried out on people without symptoms suggestive of disease are called screening tests. Good screening tests are very hard to find and the benefits of even those that are already in place are increasingly being called into question by medical experts.

One thing that may help is for people to understand that risk to health can only be reduced, not eliminated. The public only ever hear stories of cases where people tragically become seriously unwell, or perhaps have very rare conditions. Understandably, this provokes anxiety. Consequently, it often feels harder to reassure patients, who may consult several times and to different services during the same illness.

Rather like our police force, GPs can only practise in this pragmatic and cost-efficient way with consent. Whilst we should as a society seek to minimise risk as much as possible, if we continue to pursue the elusive goal of eliminating health risk altogether using healthcare, we will deny access to healthcare for the sick, cause harm by unnecessary and inappropriate treatments and also fail to eliminate risk.

It is important not to confuse planning healthcare for those with long term conditions with that for the normally well. There will be some with very different needs, for whom prompt treatment is much more likely to be helpful. The more difficult question is whether we can find new ways of meeting the needs of the normally well. This represents a significant opportunity for freeing up resources for those that do need medical treatment.

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