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The proposed NHS reforms: “No decision about me without me”
Andrew Lansley argued on the BMA webcast last Monday evening that the reforms were mainly an extension of those started by the Labour Government. He said that the Government's fresh aim was to reduce the size of NHS bureaucracy and its cost and to give GPs more influence.
Another big change that was not raised in that discussion was that patients are to be involved in all decisions about their care and that they are to be provided with the information for this to happen. If I was a patient and wished to become involved in all decisions about my care, I would have to get answers to three basic questions first: 1. What is the list of everything that is to be done? 2. For each item in this list, what is the diagnosis or differential diagnosis (or title to the explanation)? 3. For each diagnosis (or title to each explanation) what are the connected findings? It would be sensible for the answers to be written down by linking each diagnosis to its findings e.g. ‘∆1: Angina (Chest pain on exertion, Exercise ECG result)’ and linking each action to its diagnosis e.g. ‘GTN spray for ∆1’. This information would allow patients to be involved at different levels of decisions about their care. They can decide not to get involved further, to talk things over with a friend, to get a second opinion, to use a decision aid, to read up about the subject, etc.
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