Cancer fight 'hampered in UK by stiff upper lip'

Started Jan 30, 2013 | Discussions thread
richardplondon Forum Pro • Posts: 10,498
Re: Cancer fight 'hampered in UK by stiff upper lip'

Of course within a universal healthcare system there is no rational reason to withold symptoms from your doctor, or to delay a consultation. But who is truly rational about his or her own health?

Often public healthcare schemes are accused of fostering a feeling of entitlement. But IMO the users of a public funded system tend to be aware of the need to call on its resources in a proportionate manner.

The users of a private insurance funded system, however, tend AFAICT to be the ones with the attitude of basically unlimited entitlement - and consequently litigious if tests and treatments are not carried out. This expectation is what a public funded component is then seeking to match.

This throws up some interesting quirks, which may go some way toward explaining the large disparity in tests and investigations done between (for example) USA and UK experiences of the same condition.

The UK Guardian newspaper ran an article in their Saturday magazine recently, asking various doctors what kinds of treatments or healthcare services they would not undertake for themselves, if offered. It is usual in lay discussions to always presume "more is better" - more tests, investigations, more aggressive and prompt treatment - but a policy which delivers ever more of these things is not always in the patient's interest. What the patient most needs, is an appropriate level of monitoring and care.

Apart from the usual swipes at particular treatments in this article - on which the medical profession is by no means undivided - one of these doctors mentioned general "health and lifestyle check-ups" as not being a great idea. This was specifically about the planned package kind - where someone who has no symptoms or specific raised risk, goes anyway to have a proactive screening for undetected problems. This doctor thought it was on balance less rather than more beneficial to the patient, to have these investigations - due to the tendency to then aggressively treat some instances of disease that would otherwise have remained symptomless and unproblematic. Other more problematic instances would have emerged anyway due to their symptoms, in which case the patient is no worse off overall - if alertly responded to then.

Treatment itself brings a raised risk; and within a reactive rather than proactive regime, the patient has a reduced chance of getting unneeded treatment, which is a counteracting benefit to the slight chance of picking up a problematic disease a little later.

Evidence-based healthcare sometimes throws up non-intuitive statistical effects like this, and we then just have to respect what the evidence actually shows - rather than jumping straight to a political conspiracy, or an its-all-about-the-money, conclusion whenever a policy based on this evidence is proposed.

I would just comment that the quality of evidence you can collect within a universal healthcare system, about the technical effects of various treatment/investigation policies in practice, will naturally tend to be more robust - than in populations where different people are getting very different kinds and levels of primary healthcare delivery, due to aspects other than their health needs.

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