Firmly steer Mrs Ford towards accepting the treatment he has recommended?
Mrs Ford has suffered from high blood pressure for some years, and is developing heart failure, the symptoms of which are affecting her ability to work and her quality of life. She is unhappy with the treatment that she has received on the NHS and has self-referred to Dr Liebowitz, a private consultant cardiologist.
Dr Liebowitz has examined Mrs Ford and carried out tests to establish the options for her care. There are several different treatments available but Dr Liebowitz believes that the one most likely to be of overall benefit to Mrs Ford is an ACE inhibitor, which will help both her high blood pressure and heart failure. Dr Liebowitz recommends a drug which is newly on the market. He is aware that ACE inhibitors can cause a range of adverse reactions, including low blood pressure, elevated potassium leading to potentially fatal abnormal heart rhythms and damage to the kidneys - but has not yet explained this to Mrs Ford.
So, in a nutshell, that's how I'd suggest we proceed. At the very least we should be able to stabilise your condition and slow the deterioration, and many patients who are on this type of drug do show signs of real improvement after just a short while.
It sounds a little too good to be true. I've heard promises like that before. Are you sure it will work? What about complications?
Well, there is always a slight risk of any treatment not working, or causing side effects. Even a simple aspirin can be harmful in certain circumstances. But even though this is quite a new version, ACE inhibitors have been around for a while, and there is a fair amount of information about how they work and the sorts of things that can go wrong. Obviously we'd keep you under review and if there are any problems we can easily take you off it and have a re-think.
I'm just not that sure, doctor. What do you think? Would you be happy to take this medication if you were in my position?
Dr Liebovitz told Mrs Ford that, if he were in her position, he would try the recommended treatment because it offered the best chance of improving her condition and controlling and reducing her symptoms. He reiterated that no treatment is entirely without risk, and emphasised that she needed to take into consideration the small possibility of an adverse reaction, but he didn't go into any detail about the potential side effects of taking the new medication.
5b. The doctor explains the options to the patient, setting out the potential benefits, risks, burdens and side effects of each option, including the option to have no treatment. The doctor may recommend a particular option which they believe to be best for the patient, but they must not put pressure on the patient to accept their advice.
19. You should give information to patients in a balanced way. If you recommend a particular treatment or course of action, you should explain your reasons for doing so. But you must not put pressure on a patient to accept your advice.
32. You must tell patients if an investigation or its treatment might result in a serious adverse outcome, even if the likelihood is very small. You should also tell patients about less serious side effects or complications if they occur frequently, and explain what the patient should do if they experience any of them.
(Consent: patients and doctors making decisions together paragraphs 5b, 19, and 32)