Editor's Blog

Is this 'evidence' or a 'best guess'?

Many years ago, when I first started working as a birth educator (in the days when antenatal education did focus primarily on preparation for labour and birth rather than preparation for becoming a mum or dad) I used to discuss with my groups the ‘informed choice’ questions.

I believe many educators are still using them today to help parents make decisions about what interventions they want in labour or for their babies. The acronym to help parents remember these questions was BRAN, and the questions were:

  • What are the BENEFITS of having this intervention?
  • What are the RISKS?
  • Is there an ALTERNATIVE?
  • What would happen if we did NOTHING?

BRAN quickly expanded and before I stopped leading antenatal classes, it had become BRAINS with the two extra letters standing for:

  • What does my INSTINCT tell me about this intervention?

I’m not entirely sure that the expanded version was better than the original, firstly because the more letters there were in the acronym, the harder it became to remember what each one stood for (somewhat defeating the point of having an acronym in the first place), and also because the focus of the extra questions was different from the original ones which was to enable robust communication with professionals in the interests of obtaining information.

Given my history with BRAN, I was fascinated to hear on the radio recently that the NHS in Wales is about to launch a Four Questions campaign to encourage patients to question their GPs and other health professionals about treatment being proposed for them. The four questions are:

  • What are my options?
  • How likely is it to harm or benefit me?
  • Do I really need this?
  • What can I do to help myself?

The Chair of the Academy of Medical Royal Colleges in Wales, has said that : "In Wales in particular, there's still the idea that 'doctor knows best' and, interestingly, some clinicians who come to work here say patients are that little more passive, not so assertive”.

I wouldn’t be so sure that patient passivity is more common in Wales than in other parts of the UK. As citizens of each of the four countries of our United Kingdom, we have all (even if very young) been brought up in a culture which has for 70 years nurtured the belief that medicine and medical technology can solve all our problems.

Of course, this idea has been very bad for us: very bad for doctors and other health care professionals because it has led them to believe that they truly can deliver all that the public believes they can deliver, and very bad for us ordinary people because we have been doomed to constant disappointment since medicine can only sometimes keep us well and only sometimes make us better if we get ill.

And much as I think the idea from Wales of the ‘Four Questions’ is excellent, it won’t solve all the problems of the health service overnight. And the reason is that we can question our doctors, obstetricians, midwives all we like, but they will (rightly) try to answer us by citing ‘the evidence’ and ‘the guidelines’.

And ‘the evidence’ is always evolving, and ‘the guidelines’ are often a ‘best guess’.

The words ‘best guess’ are a quote because on the same radio programme where I learned about the Four Questions, I also discovered that recent advice to parents to delay introducing eggs and peanuts and other potentially allergy-stimulating foods into small children’s diets is, in fact, a ‘best guess’. The latest research, in fact, suggests that it may be a good idea to introduce such foods as early as possible into babies’ diets, even from 4 months, because the developing gut appears to accept such foods very easily at this stage, accustom itself to them, and therefore enable the child to grow up without developing any allergic reactions to them.

So what are parents meant to do now? Perhaps the final question we need to ask our health care professionals (who are doubtless trying to do their best) is:

Is the information you’re giving me reliable or a ‘best guess’?



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