Making mindset matterBMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j674 (Published 15 February 2017) Cite this as: BMJ 2017;356:j674
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Crum et al. argued that mind-sets are important in medical treatment and then refer to a number of empirical studies suggesting that the way patients are informed about their condition and their treatment, influences the outcome. Giving information about risk and side effects is not a wholly neutral act, but an intervention which could have an adverse outcome. If these findings are confirmed with a whole range of health problems, it will pose an interesting legal dilemma.
According to the Montgomery judgement , doctors ought to make sure that the patient is aware of all risks involved in the various treatment options. According to this recent jurisprudence, the question of whether to explain the risks is no longer a matter for the judgement for the doctor. That said, the patient can still choose whether or not he or she wants to be informed.
The ruling also stated that doctors do not always have to inform the patient. It is not necessary “if, in the reasonable exercise of medical judgement, she considers that it would be detrimental to the health of her patient to do so; but the “therapeutic exception”, as it has been called, cannot provide the basis of the general rule.”
If it turns out to be the case that informing patients about possible harmful side effects, increases the incidence of them, at least under certain conditions, which is what Crum et al. suggest, there will be a dilemma: completely informing the patient or doing what will, on average, give the best overall outcome. Guidance regarding this dilemma from the legal profession would be helpful.
1 Crum AJ, Leibowitz KA, Verghese A. Making mindset matter. Bmj 2017;674:j674. doi:10.1136/bmj.j674
2 UK Supreme Court. Montgomery v Lanarkshire Health Board. 11 Mar 2015. https://www.
Competing interests: No competing interests