I think choice in medicine is a very difficult thing, and I think patients are often themselves uneasy about it. And you do go to your doctor because your doctor’s the expert and say, “What do you think, doctor? What should I have?” And you can ask for lots of explanations. But in the end if you trust your doctor the odds are very strongly from all the evidence that most people will do whatever their doctor suggests, probably sensibly. If you don’t trust your doctor, then go to another one and then you’ll do what the other doctor suggests [laughs]. A lot of people will come to doctors with great piles of documents they’ve printed off the Internet, some of it from rubbish sites, a lot of dangerous stuff out there on the Internet. And, you know, the doctor then will spend a long time going through them and saying why they think they’re right or not right. But in the end it is down to trust. So choice is quite difficult. And I think, you know, the same is true about choice of which hospital to go to or which consultant to be sent to. In the end you probably trust your doctor to say, “Well, Mr so-and-so at X hospital has, you know, always seems to have done very well to my patients.” And I think lots of patients, and particularly the sicker they are, don’t really want choice. They want trust. And choice and trust are in different boxes. And very often if you’re left on your own to make really life-and-death decisions it can be very upsetting. You want to be reassured by someone who seems to know.
I guess there’s another conundrum, really, isn’t there? Because in trying to present a trial as a case of genuine uncertainty, there’s a risk that the doctor may undermine your trust by sharing that uncertainty with you.
I think that’s true. I think if a doctor says, “Well, I really don’t know. You’ll have to choose”, it can be very unnerving, because you really do want him to know. Or at least you want him to, you say, “Well, all right. I understand you don’t know.” Perhaps you want him to be honest about uncertainty. I think you don’t want him to pretend that he, to pretend he’s God. You want him to say, “Well, actually not enough is known about this condition” or, “Here are the options.” But in the end you want to say to the doctor, “But of what you know, what do you think the odds are? Which way would you really go?” And in the end you want the doctor to plump one way or the other, as best they can. I mean that’s, that’s their job.
