The idea of ‘patient benefit’ is at the core of healthcare. But it can be surprisingly difficult to define in many circumstances, according to a new paper from UCL and UCLH.
Understanding more precisely what constitutes patient benefit should lead to better healthcare and research, the authors said.
Making life better for a patient is based on the notion of improving their wellbeing – but a key challenge, the authors say, is that there are different conceptions of wellbeing.
For example, people often do things which are objectively worse for their health, but they do this based on a broader conception of their wellbeing. Some patients with long-term conditions avoid medication that has side effects, so they can pursue activities that are meaningful for them – even though this may be worse for the management of their condition.
Another issue is that individual wellbeing may conflict with wellbeing at a population level. With antibiotic use, for instance, there is a balance between individual wellbeing (prescribing the treatment a patient needs) and population wellbeing (preventing antibiotic resistance).
The paper, published in the Future Healthcare Journal, is an example of how philosophy can help answer practical questions in medicine.
Lead author Professor James Wilson, from UCL Philosophy, said: “Science and medicine alone cannot tell us the best way to improve people’s wellbeing and maximise patient benefit.
“Patients have their own preferences in terms of their wellbeing, and there are choices to be made in terms of individual wellbeing and population wellbeing – so healthcare needs to reflect these nuances.”
The authors of the paper said that shared decision making between clinicians and patients was vital – so that healthcare decisions can be based on a combination of ‘objective’ measures of wellbeing as well as ‘subjective’ measures reported by patients, depending on the situation.
Dr Wilson added: “Clearly sometimes it is objective measures that matter most in healthcare - such as knowing how much oxygen is in a patient’s blood. But sometimes subjective measures should take precedence. In pain management, no test result could over-ride a patient sincerely saying they were experiencing severe pain.
“In different situations, different conceptions of wellbeing and patient benefit will come to the fore.”