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Nurses 'bemused' by doctors' resistance to decision aids

  • 17 Comments

The first evaluation of an NHS programme to spread joint decision making with patients has found nurses more open to the approach than doctors.

The Department of Health, working with NHS East of England, is trying to encourage clinicians to provide patients with more information about their condition and treatment options, and involve them more in decisions.

Findings from the first evaluation of support websites provided by NHS Direct, shown to Nursing Times, found many patients were “enthusiastic” about using the tools - which provide them with a personalised summary sheet about their condition - and keen for more discussion of options.

However, it found there are “many challenges to overcome before [the] approach can be mainstreamed”. These included resistance and lack of understanding among specialist doctors.

The report, by researchers at Cardiff University, says: “Many of the specialists stated that they would not be interested in the summary pages produced by the websites even if the patients presented them.”

Steve Laitner, a public health consultant and clinical lead for the programme, said: “Surgeons and medics are very biomedically trained and sometimes nurses and therapists and other professionals have a more holistic view of health. That can be helpful [in encouraging joing decision making and support].”

Findings from one large general hospital say: “The nurses and unit manager seemed very committed to the idea of involving patients in decision making. However, the specialist was less supportive of the idea that patients could become involved in decision making… The nurses and unit manager are committed to shared decision making but the specialist is less committed when asked directly.”

In reference to the summary sheets, it was reported: “The specialist was anxious to establish that he would not want to have to use them in his clinic. He did not want to make use of the patient’s knowledge, their knee score, the degree to which they were ready to make a decision and their personal preferences… The nurses seemed bemused by this as they thought this was a central objective of the project.”

  • 17 Comments

Readers' comments (17)

  • Doctors control the NHS and doctors continue to work in silos and protect their information. Just remember that a doctor can make a diagnosis at 9a.m change it at 9.30a.m and both will be right because they made the decision based on the information at the time - regardless of whether they ignored this information or not.

    Doctors are continuing to hold the NHS to ransom with their opinions, their greediness (some Heads of Clinical Directorates get a huge salary for this and a huge salary as a Consultant with an automatic bonus.

    Let's see if any doctors comment further on this??

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  • why on earth is everything made so complicated in the NHS just adding further costly bureaucracy and further distancing resources where they are most needed for direct patient care.

    why on earth are tools needed to communicate with patients and to enable their right to information and decisions on what affects them?

    the NHS seems to be totally hell bent on dehumanizing care as far as it can possibly go in the name of cost saving and disastrous waste of its resources so that these can be used on even more administration.

    It is clear that patients are involved, if they wish and are able, in any decision making that concerns them and their treatment. you cannot treat anyone without their consent unless it is in compliance with the mental health act. Is it too simple to communicate with the patient every step of the way as a fellow human being and equal partner in care and inform them of their condition and the choices available to them?

    have clinical skills and talking to patients to find out their needs and wants gone totally out of the window? Is this why nursing is becoming an all degree profession so that they become more skilled in using all these evaluative tools and data collection rather than providing hands on care?

    robots could probably do a far better job in meeting the needs of patients.

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  • so doctors are resisting ideas that stops them "playing God", this is not news. Doctors will resist all ideas that, they feel, take away their powers, this includes nurse specialists, nurse consultants, nurse practitioners and nurse led clinics and initiatives

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  • above. why shouldn't they, they have worked hard enough to earn their position.

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  • in addition to last comment. as long as nurses or anybody else continue to play the underdog or behave submissively this will not change.

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  • Anonymous | 2-Aug-2011 2:03 pm

    "so doctors are resisting ideas that stops them "playing God", this is not news. Doctors will resist all ideas that, they feel, take away their powers, this includes nurse specialists, nurse consultants, nurse practitioners and nurse led clinics and initiatives"

    Actually in my hospital the majority of consultants and registrars are very supportive of nurse specialists, nurse consultants and nurse led clinics/initiatives. They would find it extremely difficult to manage their workload without us.

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  • in my hospital we are extremely supportive of the doctors at all levels. it is mutual, we work in interdisciplinary teams and one group is not considered superior to another. we all work together for the common goal of caring for patients and do not have a need or the time to see who is better or superior and kowtow to one another.

    Although when I first went there very many moons ago it was a little different. the professor did a ward round once a month followed by his retinue in pecking order and on that day our poor disappointed Chief Nurse (equivalent of a floor manager for several wards) went to the hairdressers to have her grey hair tightly permed before the big even and then she fluttered around the old almost retired grey haired prof. pushing a type of mobile pulpit around in front of him on which she placed each patient's notes and turned the pages for him. we also took delight in putting para film in the earpieces of the most junior doctors' stethoscopes but they never admitted to the prof. that they didn't hear what they were supposed to!

    thank goodness this circus has long since retired!

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  • Anonymous | 2-Aug-2011 1:33 pm

    ‘It is clear that patients are involved, if they wish and are able, in any decision making that concerns them and their treatment. you cannot treat anyone without their consent unless it is in compliance with the mental health act. Is it too simple to communicate with the patient every step of the way as a fellow human being and equal partner in care and inform them of their condition and the choices available to them?’

    Exactly – you are spot on, and your ‘why’ question is also one I would ask ! That is the ethico-legal basis of treatment – patients are informed of clinical outcomes, then patients make the decision about what treatment to accept.

    But it was not clear to me, from reading the summary, whether some doctors were only resistant to having discussions with patients, based around these ‘summary pages produced by the websites’. It is possible, that some resistance was because ‘It makes more sense for me to describe the patient’s clinical condition to him from scratch, in as much detail as he needs, without complicating the issue by ‘talking around some less-specific online blurb’’. That position, could be justified – but making a patient’s decision for him, is not !

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  • Anonymous | 2-Aug-2011 2:03 pm

    do you have a reason to use this article as an excuse for doctor bashing?

    apart from venting your anger,which is ok, but is it in any way constructive?

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  • tinkerbell

    I have never understood this need to keep 'having a go at one another' so that every day turns into a battle. I know it might be naive to expect that we should all try and get on with one another, be free to express our opinions without putting one another down all the time. Yesterday i had a pretty draining time with one of our GP's (they have now taken over the contract for our inpatient service) who was unnecessarily rude to me when i expressed concerns about a patients wellbeing, when i told him how i felt he said he wasn't prepared to work with me anymore and could i get someone else to talk to him and did i want to 'take it to the top'. No i didn't want to take it the the top, wherever that is, i just wanted to establish that we can be civil to one another and there is no need to bark at a nurse because she has expressed a serious concern about a patient however busy he might have been. I realise we are all busy & stressed out of our minds on occasions, but we all need to see the bigger picture and that is if we can't get along with one another then ultimately the patients suffer whislt we are all arguing and fighting and trying to score points. What's wrong with trying to resolve our conflicts with one another between one another, without 'going to the top'. Maybe he'd had a previous bad experience and thought that's where we were going but i never had a chance to explain as i could see he and I were going nowhere, so i was quite happy to remove myself and allow him time to calm down and discuss it with a more senior manager whilst i dished up the dinners.

    I'm sure our initial intentions, when we came into the caring profession, were to help others, not spend our time having a right royal bun fight with one another. There are good doctors, good nurses, bad doctors, bad nurses, speak as you find but lets not all take it out on one another.

    Ultimately another manager had to become involved and discuss the matter and a new policy is to born out of this on how to inform a doctor of a serious concern. Unbloodybelievable! No wonder the NHS is on its knees. Oh dear, i really am glad i'm on a day off today and can go for my long lie down.

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