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Compromising Patient Care

The current emphasis in medicine and health management on purely scientific measures for successful health care is compromising the quality of patient care, according to the Director of Otago University's Bioethics Research Centre, Professor Donald Evans.

Evans says that while science plays an important role in describing and treating diseases and conditions, there is a danger in elevating science above everything else, rather than focusing on the needs of individual patients.

He says there is a temptation to seek universal answers to health care delivery problems by employing general theories of health economics and purely scientific descriptions of health needs, treatments and outcomes. This can lead to gross injustices and serious harm to patients.

In times of economic stringency and soaring demand for health care, there is much talk about efficient use of resources, notes Evans. Cost benefit analysis has become the watchword, with the focus being on "maximum health gain" and successful treatment outcomes.

However, a concentration on scientifically measurable outcomes may mislead health care providers about the effectiveness of their procedures, with adverse effects on patient health and well being.

Evans gives the example of a study of 75 patients whose hypertension was well controlled by drugs. The patients, their relatives and their doctors were asked to complete a quality of life questionnaire.

Fewer than half the patients (48%) and only 1% of relatives felt that there had been any improvement in their quality of life. This contrasted sharply with the doctors, who all believed an improvement had been achieved.

"The gap between the clinicians' judgements on one hand and that of the patients and relatives on the other can be attributed to the simple fact that the clinicians had one measurable feature of their patients' condition in mind -- bringing the diastolic blood pressure below 100mm Hg," Evans says.

There are just as many fish hooks in assessing the health needs of patients, Evans says. Here managers might hide behind medical language in prioritising services according to a limited range of needs, such as the presence of disease conditions.

Not all health needs consist of having a disease. A good example is assisted procreation services which many health authorities refuse to purchase, arguing that infertility is not a disease. Yet infertility causes misery for a significant proportion of couples and can be readily treated in many cases through medical techniques such as in vitro fertilisation.

Evans says a more holistic approach is needed in health care, with health professionals being educated so as to become more aware of the consequences of their medical interventions on the lives of their patients.

He recommends the inclusion of bioethics and study of the Medical Humanities in the training of midwives, doctors, physiotherapists, health managers etc. An integrated approach should be used, so the ethical, clinical and fiscal dimensions of individual cases are considered together.