The Crisis in Caring and dangerous inference

I note with gratitude DC’s digging of the College of Medicine arising from Prince Charles’ Foundation for Integrated Health. The College website, if looked at superficially and uncritically, may seem like a good thing – caring! sharing information with patients! recognising that targets can interfere with good clinical care! – in fact, all the same kind of themes I’ve been writing about and supporting for years.

The problem with this enterprise is that it believes, wholeheartedly, that complementary – non evidence based – interventions are automatically valid. Not for them the systematic review of the negative trial. Not only do these kinds of interventions waste time, money, effort and energy, they also mean that decent, proven interventions become invisible to the customer (for patients should be supported by knowledgeable professionals keen to provide treatment on the basis of evidence, not personal bias.)

But even worse, even more dangerous and unfair, is the underlying assumption that only those doctors willing to provide non evidence based treatments ‘care’ for patients. In fact, what evidence based doctors know is that things like continuity of care, time, and good explanations, as well as things like the colour of tablets  –  the ‘placebo’ effect, are all essential valuables of modern medicine. What doctors like myself would state is that ‘caring’ is not a bolt on, but the normal state of what it is that I do.  I would consider it ethically wrong – never mind uncaring –  to prescribe or encourage interventions which I knew to be ineffective. In fact, far from ’empowering’ anyone, recommending non evidence based interventions to patients is a form of patronising ‘doctor knows best’ which I thought we were trying to get rid of. And of course, if you are a therapist who also runs a business, it may be that one has conflicting interests when deciding what to recommend to people.

This College is capable of doing harm to those of us trying to provide professional, evidence based, compassionately delivered health care. Non proven interventions do harm, and I hope that the high profile supporters of the College think again about putting their names to it.

One Response to “The Crisis in Caring and dangerous inference”

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