Hive Health

Patient choice is a hot topic in healthcare, so it was interesting to review the latest clinical guideline from NICE: Medicines Adherence and Patient Choice 

Hive’s focus is patient-centric communication, but we don’t claim to have all the answers on the perplexity of patient choice. It’s a tough one for NICE too, who admit that there are gaps in evidence-based learnings. I picked up on a more basic disconnect – NICE’s policy is one of optimal Adherence, but it is Choice that underpins any behaviour. So, more patient choice infers that adherence is optional rather than optimal.

Patient choice embraces much more than adherence. How the two fit together might go like this: more honesty and understanding between doctors and patients leads to shared decisions about treatment. This increased choice translates into a prescription that is handed over with the mutual assurance that every item will be taken as prescribed. Less wasted medicines and consultation time, arguably better health outcomes for individuals.  

Can this happen when medicine and humans are an unpredictable mix? Not only do people respond differently to treatments, but our choices change from moment to moment. We try things, get a result, forget what it was that gave us that result, and start from the beginning. We’ve only our own bodies to give us feedback, and sometimes that feedback isn’t clear enough to justify repeated behaviour.  

Still, people like the sound of choice, at least in theory, and NICE outlines the many ways that doctors can improve at delivering that right. The guidelines are a step in the right direction, albeit a giant leap from current practice. Eyes will be rolling in surgeries at the thought of fitting more whys and hows into a standard consultation.

Of course, the real mental shift lies not with providers but with users. NICE has not yet issued patient guidelines on choice, and whether or not they do, every patient must find out for themselves what choice really means and how to play it out. I often politely accept a prescription knowing I’ll never fill it. I think I would be braver in talking to the doctor about this if I had proof that there is value in doing so.

 We need a bit of genius to get this right. Let’s teach kids about choice: how to visualise the results of actions, verbalise the decision and analyse the outcome. What else – any ideas?