A very interesting article in yesterday’s New York Times discusses how the National Health Service (NHS) in England is clamping down on patients using both their own money and the NHS services to get treatments for the same condition at the same time. The article primarily discusses the case of a woman with breast cancer where the NHS wouldn’t pay for Avastin, and told her if she paid for it herself, she would have to pay for all her medical treatments for breast cancer.

The article also discusses the complexity and apparent confusion within the medical community and the NHS about how this policy is supposed to be implemented. But it doesn’t delve into how this policy would undermine patient-physician communications, quality of care, and the integrity of the medical record. What would happen if a patient knowing that paying on their own for treatments not covered by the NHS could cause the NHS to deny them coverage for this condition. Would they then not tell their physician about this “other” treatment they were receiving? Certainly this could affect the quality of their care and possibly lead to drug-drug interactions. And then if the physician found out about it, how would this undermine their trust in what else the patient told them? And what if the patient decided it was important to tell their physician that they were getting this other treatment, but asked that it not be recorded in their medical record? Could the physician be liable if something happened because of this – possibly because of treatments ordered by another clinician who didn’t know about the “other” treatment not included in the medical record?

This situation reminds me a little of 10+ years ago when patients were reluctant to talk to their clinicians about the complementary treatments – such as acupuncture or herbals – they were be taking. Now it it encouraged for physicians to ask, and patients to tell ,their clinicians about these non-prescription treatments because of the known (and possibly unknown) interactions that can occur with prescription treatments.

It all just makes my head shake and shoulders shudder. But at least I don’t have to wonder why the NHS is adopting this policy – it’s all about money. I guess that they have decided that if a patient can afford to pay for something expensive that the NHS hasn’t approved for them, then they can afford to pay for all of their care for that illness.

And now for the irony. Towards the end of the New York Times article it notes that “…Mrs. Hirst was told early this month that her cancer had spread and that her condition had deteriorated so much that she could have the Avastin after all — paid for by the health service. In other words, a system that forbade her to buy the medicine earlier was now saying that she was so sick she could have it at public expense.”

Any thoughts?