Many doctors aspire to excellence in diagnosing disease. Far fewer, unfortunately, aspire to the same standards of excellence in diagnosing patients’ preferences for their care. Because doctors are rarely made aware of an erroneous preference diagnosis, it could be called ‘the silent misdiagnosis’. Misdiagnosing patients’ preferences may be less obvious than misdiagnosing disease, but the consequences for the patient can be just as severe.
Patients’ preferences matter: stop the silent misdiagnosis outlines the scale of the problem, showing that:
-when they are well informed, patients make different choices about treatment
-what patients want often differs from what doctors think they want
-there are significant variations in care across geographic regions.
This sets out how commissioning decisions are informed by assessments of need made by experts – by public health specialists at population level and by doctors at individual level – and that clinical assumptions are made about the right level of treatment for the level of need in the population.
Despite this there is huge variation in the rates of intervention, suggesting that for some procedures, some of the variation could reflect over-provision of services, rather than under-provision. As a result, the NHS must focus on the quality of decision making in care.