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A difficult decision

Jobbing Doctor's patient wants advice about a procedure he knows nothing about - what to do?

Jobbing Doctor's patient wants advice about a procedure he knows nothing about - what to do?

One of my jobs as a Jobbing Doctor is to be an advocate for my patients.

It can be a very difficult and frightening scenario when they are faced by advice from various specialists in hospital; particularly if different members of the same department give conflicting advice.

Patients will come and talk to me and ask whether they should have procedure A done, or operation B or treatment course C. I know that they are likely to take my advice, and will make their decision based largely on what I tell them.

This is a big responsibility that I take very seriously, and it also puts me into a conflict situation with colleagues working in the hospital sector. To be frank, they don't like it. This can be difficult when they are being advised by people whose opinion I don't always rate.

There is a spread of ability in all walks of life. The healthcare sector is no different, and there are wonderful consultants and terrible ones, and all stages in between: this also applies to junior staff, nurses, and (yes, I know) GPs as well.

So if somebody is being advised to have particular tests by a clinician in a department that I do not rate, then I will exercise my responsibility to advise accordingly: it is my professional role.

I was musing on this the other day when I saw a patient to whom it has been suggested to have a particular procedure done - a vertebroplasty for osteoporosis.

I explained it to the patient in simple terms - a bone in your spine has collapsed and they want to fill it with concrete to help relieve the pain. I hope that my description is accurate.

I was asked by her if she should have the procedure done.

Problem.

I don't know anything about vertebroplasty, I didn't know it was done at the local hospital, have never had a patient who has had it done, and had never heard about it.

I temporised. I told the patient that I would do some research on it (that always sounds much better than saying that I hadn't a clue and needed to look it up!)

I have asked two radiologists and an unrelated pain consultant about their views on it (their views were, respectively, ‘not sure', ‘not keen' and ‘doesn't sound the right type of patient to me').

I have read the NICE guidelines, and looked it up on the internet. I have had a think about it. I need to have a decision ready for when my patient reattends next week.

Of course my decision may well be that I can't advise her; or it might be that I will list all the pluses and minuses; or I could say that the doctors in the hospital are good people and they wouldn't advise something that wasn't beneficial.

That will not do for my patient. She will want me to get off the fence and tell her what I think she should do. If I say ‘do it' she will; if I say ‘don't do it' she won't.

It is a pretty difficult decision.

I have to find out who is going to do the procedure, and whether they have done it before, and if there is a specialist spinal surgeon available within the trust.

I still have to decide. I don't really know, but I am leaning towards advising her against it (I don't think she is an ideal candidate for the procedure).

But I am not the one who is in constant pain.

What to do?

The Jobbing Doctor is a general practitioner in a deprived urban area of England

Jobbing Doctor

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