‘The Patient Paradox’ by Margaret McCartney

‘The Patient Paradox: Why Sexed-Up Medicine is Bad for Your Health’ is an absolutely brilliant book and one which I thoroughly recommend. Margaret McCartney is a Glasgow GP who also writes for the BMJ, several newspapers and appears regularly on Radio 4. She is really keen to promote evidence-based medicine, and gets really riled at claims which are made about treatments and interventions which in reality are less than evidence-based.

The paradox in the title, as she shows, is that the iller you are, the less likely you are to be able to access health services. This is because so many interventions are now aimed at healthy people, ‘pre-illness’ if you will, and those interventions are most likely to be taken up by people who are least likely to need them. She uses the example of screening to illustrate this point, but also critiques health charities, big pharma and governmental policies which have been more based on political ideology than evidence of improvement in health and services. If you liked Ben Goldacre’s ‘Bad Science’ I am sure you would like this, it’s very much on the same lines, and meticulously referenced (unlike many of the claims she is critiquing). I really like how not only does she explain her concerns in language that non-medics could easily follow, but she backs up all her points with strong evidence and also outlines where there are gaps in evidence too (in other words where people/companies are making claims about products/policies but where there is no reliable research to substantiate those claims).

My one slight worry is that some people might read this and think that she is saying that there is no point in getting screening at all. I don’t think she is saying that, but what she is saying is that we (health services, policy makers, patients) need to consider the evidence and make informed decisions rather than be brow-beaten into something which may not necessarily be as useful for us as is claimed. However there are just so many examples where services do not live up to this need that it is a bit relentless in the book.

Personally I think this book (like ‘Bad Science’) should be compulsory reading for all medical, nursing and allied health professional students. If I have a group of OU students for one of my courses (not sure yet, still waiting on student numbers) I will definitely be suggesting it to them as extra reading, as it is highly relevant for that course and I kept thinking ‘ooh we talk about that in the course’ throughout the book. Highly recommended.

2 thoughts on “‘The Patient Paradox’ by Margaret McCartney

  1. This made me laugh because I remember my mum going to her GP after she got out of hospital having had her first heart attack. She was asked why she hadn’t been in and let him know in advance what was happening – having it without warning meant that he couldn’t fill in all the boxes on his computer properly and made all the paperwork far more difficult.
    He was upset about exactly what this is talking about, i.e. that there couldn’t be some kind of pre-intervention.

  2. Yes. The book was talking about how now people are deemed to have pre-hypertension, pre-diabetes etc – it’s ridiculous!

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