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The Patient Paradox
Welcome to the world of sexed-up medicine, where patients have been turned into customers, and clinics and waiting rooms are jammed with healthy people, lured in to have their blood pressure taken and cholesterol, smear test, bowel or breast screening done. In the world of sexed-up medicine pharmaceutical companies gloss over research they don't like and charities often use dubious science and dodgy PR to 'raise awareness' of their disease, leaving a legacy of misinformation in their wake. Our obsession with screening swallows up the time of NHS staff and the money of healthy people who pay thousands to private companies for tests they don't need. Meanwhile, the truly sick are left to wrestle with disjointed services and confusing options. Explaining the truth behind the screening statistics and investigating the evidence behind the hype, Margaret McCartney, an award-winning writer and doctor, argues that this patient paradox - too much testing of well people and not enough care for the sick - worsens health inequalities and drains professionalism, harming both those who need treatment and those who don't.
335 pages, Paperback
First published February 22, 2012
28 people are currently reading
300 people want to read
About the author
Margaret McCartney
9 books13 followersMargaret McCartney is a GP in Glasgow, and has three children. She started writing for the press after being infuriated by an article in a newspaper which claimed that CT body screening was the way to stay well. Since then she has written for most UK newspapers, as well as the British Medical Journal (BMJ), other magazines such as Vogue and Prospect, has had columns in the Guardian and the FT Weekend, and is a regular contributor to BBC Radio 4’s Inside Health. She has won prizes from the Medical Journalists’ Association and the European School of Oncology, as well as the Healthwatch award.
She has a strong interest in evidence, professionalism, screening and risk. She blogs and tweets. The Patient Paradox is her first book
She has a strong interest in evidence, professionalism, screening and risk. She blogs and tweets. The Patient Paradox is her first book
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Displaying 1 - 15 of 15 reviews
April 19, 2012
I bought this after reading an article in the independent written by the author, a GP, outlining why she does not attend cervical and breast screening tests. Her article mirrored my views on screening exactly so I bought the book straight away. I wasn't disappointed. It is fantastic to read a critique of the medical industry by a GP and so refreshing to see an alternative view to the constant media brainwashing we're subject to on a daily basis, especially regarding cancer. I think everybody should read this book, use the info provided to stand up to the medical 'experts' and take back some control of our bodies!!
December 13, 2015
A very interesting look at modern healthcare and over-medicalisation. Some parts are specific to the NHS but most are relevant to any health service. As a patient, it was revealing to hear a GP's side of the story and it explained some of the experiences I have had with the NHS. The influence of health charities, and of pharma on them, was an eye-opener and not something I had considered before.
I bought this book because it was recommended by Ben Goldacre and I think its content compliments Bad Science and Bad Pharma.
This quote from the book's epilogue provides a succinct summary of the core message of the book:
I bought this book because it was recommended by Ben Goldacre and I think its content compliments Bad Science and Bad Pharma.
This quote from the book's epilogue provides a succinct summary of the core message of the book:
"Addressing inequalities is where the biggest gains in health are to be made, not our current model of taking well people and screening them into diagnoses they don't need and won't benefit from."
August 13, 2012
A fantastic read. Lots of new information.
Written clearly and concisely for both lay and medical people.
As a GP, it made me change my practice right from the first page.
I will be holding on to this book as an empowering aid to providing good medical advice and clinical care and resisting unnecessary influences on my practice.
Written clearly and concisely for both lay and medical people.
As a GP, it made me change my practice right from the first page.
I will be holding on to this book as an empowering aid to providing good medical advice and clinical care and resisting unnecessary influences on my practice.
October 18, 2019
The book relies a bit too heavily on overtone for my taste; but it does make some solid data-backed points. The message is also empowering to patients and a corrective criticism towards doctors and policy makers. Overall, okay
May 15, 2013
This book has been my daily read on the way to work, and I found it riveting. It raises serious questions about (amongst other things) whether screening programmes are really worth having, why the NHS spends more resources on looking after the "worried well" rather than the very sick, and the problems with health charities getting involved in medical decision making. Although the author used medical terms, I found it easy to read,it is written for the lay-person, and there is a useful glossary at the back. Like any well researched book, there is an extensive bibliography also, and I found this very useful on my e-book copy, to follow up articles the author had referred to.
May 27, 2014
Everyone should read this - important and eye-opening (although she does tend to stick to the out-dated and misleading NHS advice about diet - she recommends too much fruit and whole-grains...just sugar in another form...if she'd written more about the benefits of low carb diets she would have been more credible). Cut dowm on the fruits, people...step up on the veg...
July 30, 2019
Quite simply this how the medical profession which includes doctors , the NHS , researchers , pharma companies , charities , the media , educationalists and other side riders such as celebrities have all unwittingly conspired to make healthy people become patients .
Once you become a patient it is very difficult to free yourself in fact it becomes a way of life . The "worried well " is a good phrase in summary .
It is always satisfying when you find a writer who reflects one's own feelings and Margaret Mcartney does just that for me .
The NHS encourages this by constantly encouraging people to go for tests for possible prostate cancer , breast cancer etc despite the evidence of the usefulness of the results being pretty unsubstantiated . If you visit your doctor ,the surgery is littered with advice on this that or the other encouraging the public to worry and become alarmed about their health . If you pick up your prescription at the pharmacy the same sort of literature . Every winter the usual scare stories emerge about a new killer strain of the flu virus and the necessity of having a flu jab .
The classic of course is the giving out of statins like sweets to anyone who just might have a slightly high cholesterol level . A recent Lancet paper recommended giving statins to anyone over 50 because in case they have high cholesterol level later in life . I might be easier and cheaper to suggest they eat less junk food and exercise more . You take them , have an unfavourable reaction so try these pills to overcome the side effects and before you know it you have inadvertently become a full time signed up patient . Facebook must be jealous of these tactics .
The pharma companies would be pleased . More pills more money . They do have to spend a lot of money buttering up doctors and researchers to get on board with all this over prescription . The amount of seemingly unbiased research by scientists and Universities that seems to be financed by pharmaceutical companies is worrying .
Health charities aaaah ! They are all so virtuous , selfless and staffed by nice people who only have other's interests at heart . A lot I am sure are genuine and very worthwhile but unfortunately large charities seem to be more interested in promoting their own diseases in a dash to get a bigger slice of the donation cake . I used to admire the Macmillan cancer charity but in a crowded market place with other charities joining in the bun fight they seem to have gone down the alarmist/ tugging at your heart strings advertising route . No disease no matter how small usually has several charities all fund raising like competitive businesses .
The media . One word will suffice well two actually . The Daily Mail . They started it all but the rest of the media have caught up especially the non print media . Nothing like a good health scare story . My favourite was a professor called John Oxford who is always banging on about bid /swine /ebola / zika . Anyone remember the medical specialists calling for the 2016 Olympic games to be cancelled because of the Zika threat ? Rory Mcilroy pulled out of the games because of this . I wonder what happened to him . Celebrities are always celebrating their recovery from being minutes from death due to a slight cold or being photographed on their death bed in hospital having suffered from a flea bite .
Don't get me wrong if I was diagnosed with a serious illness I would be banging down the hospital doors for treatment but this book is a timely and serious look at health issues today and how many bodies are racing along on the wrong road leading to the medicalisation of society .
BTW these same bodies are only just saddling their horses to promote the issue of mental health in society and getting up speed very quickly . " Overcoming the last great taboo " is their marketing strategy
Once you become a patient it is very difficult to free yourself in fact it becomes a way of life . The "worried well " is a good phrase in summary .
It is always satisfying when you find a writer who reflects one's own feelings and Margaret Mcartney does just that for me .
The NHS encourages this by constantly encouraging people to go for tests for possible prostate cancer , breast cancer etc despite the evidence of the usefulness of the results being pretty unsubstantiated . If you visit your doctor ,the surgery is littered with advice on this that or the other encouraging the public to worry and become alarmed about their health . If you pick up your prescription at the pharmacy the same sort of literature . Every winter the usual scare stories emerge about a new killer strain of the flu virus and the necessity of having a flu jab .
The classic of course is the giving out of statins like sweets to anyone who just might have a slightly high cholesterol level . A recent Lancet paper recommended giving statins to anyone over 50 because in case they have high cholesterol level later in life . I might be easier and cheaper to suggest they eat less junk food and exercise more . You take them , have an unfavourable reaction so try these pills to overcome the side effects and before you know it you have inadvertently become a full time signed up patient . Facebook must be jealous of these tactics .
The pharma companies would be pleased . More pills more money . They do have to spend a lot of money buttering up doctors and researchers to get on board with all this over prescription . The amount of seemingly unbiased research by scientists and Universities that seems to be financed by pharmaceutical companies is worrying .
Health charities aaaah ! They are all so virtuous , selfless and staffed by nice people who only have other's interests at heart . A lot I am sure are genuine and very worthwhile but unfortunately large charities seem to be more interested in promoting their own diseases in a dash to get a bigger slice of the donation cake . I used to admire the Macmillan cancer charity but in a crowded market place with other charities joining in the bun fight they seem to have gone down the alarmist/ tugging at your heart strings advertising route . No disease no matter how small usually has several charities all fund raising like competitive businesses .
The media . One word will suffice well two actually . The Daily Mail . They started it all but the rest of the media have caught up especially the non print media . Nothing like a good health scare story . My favourite was a professor called John Oxford who is always banging on about bid /swine /ebola / zika . Anyone remember the medical specialists calling for the 2016 Olympic games to be cancelled because of the Zika threat ? Rory Mcilroy pulled out of the games because of this . I wonder what happened to him . Celebrities are always celebrating their recovery from being minutes from death due to a slight cold or being photographed on their death bed in hospital having suffered from a flea bite .
Don't get me wrong if I was diagnosed with a serious illness I would be banging down the hospital doors for treatment but this book is a timely and serious look at health issues today and how many bodies are racing along on the wrong road leading to the medicalisation of society .
BTW these same bodies are only just saddling their horses to promote the issue of mental health in society and getting up speed very quickly . " Overcoming the last great taboo " is their marketing strategy
April 27, 2019
Brilliant book !
Now that I have a better understanding of how the NHS works I can see why my GP makes the decisions he makes. A lot of the time it's about meeting targets not the wellbeing of the patient.
Now that I have a better understanding of how the NHS works I can see why my GP makes the decisions he makes. A lot of the time it's about meeting targets not the wellbeing of the patient.
December 15, 2020
It uncovers the essence of medicament and the dark backbone of the modern medical system.
October 12, 2012
I found this compulsive reading and it raised some interesting questions in my mind about healthcare today. Do screening programmes really work? It almost seems heresy to question whether they are really a good thing but this is what this book does. The disadvantages and risks of taking part in screening programmes are detailed in this fascinating book and you can compare those with the bright and cheerful leaflets you receive when your latest appointment appears in the post.
For many years I have not even thought to question why I am attending these appointments. In the last couple of years I have started to wonder what the point was and what the risks are. Breast cancer screening carries risks and does not actually identify that many cases. The author discusses the effect of anxiety and distress on women when they receive a recall letter. If it is a genuine case of early cancer being diagnosed by the mammogram then the distress may be worthwhile as the cancer can be treated. But what if it is a false positive and the woman concerned goes through invasive procedures and an anxious few weeks before she is told it was a benign condition? What effect does the stress have on her health? Is it possible that the risks outweigh the advantages for many people and shouldn’t we be provided with as much information about the downside as well?
The author believes that patients should be given all the information they need to make informed choices about their treatment. They should not be worried about whether their doctor is going to make money out of their treatment. Most doctors are ethical in what they do and genuinely want to provide the best possible treatment for their patients regardless of cost. Government targets to do with not smoking, drinking alcohol in moderation, losing weight etc can overshadow every doctor patient consultation often to the detriment of the patient. Preventive medicine and screening the worried well is fine in an ideal world but when resources are limited most money should be spent on those who are sick and who have illnesses and conditions which need treating.
I was surprised to read about the effects of the two week referral window for suspected cancer cases. According to analysis of cases it seems that fewer cases are picked up from the two week urgent referrals than there are picked up from the eighteen week routine referrals. Doctors have even had it suggested to them that they should refer all cases through the two week process. The reason for these results are complex and partly related to the fact that the human body can only produce a certain number of symptoms and there may be common to several serious conditions and a much larger number of trivial conditions. It is impossible for doctors to decide which is which without further testing but they have to make some sort of judgement before they can refer their patients for further testing. This is putting the cart before the horse in my opinion.
This well written and interesting book will make you questions whether the NHS has got its priorities right. There are plenty of references to the sources of the facts and figures the author quotes in the text and an index. Maybe the NHS should stop spending large chunks of its money on the worried well and on people who have no symptoms of serious illness but who might have in the future. Isn’t it better to spend the money on the people who need treatment rather than force feeding people statins which might protect some people – no one knows which people – from heart attacks and strokes in future? Healthcare should be for the sick and not for the worried well and it should not be about targets.
For many years I have not even thought to question why I am attending these appointments. In the last couple of years I have started to wonder what the point was and what the risks are. Breast cancer screening carries risks and does not actually identify that many cases. The author discusses the effect of anxiety and distress on women when they receive a recall letter. If it is a genuine case of early cancer being diagnosed by the mammogram then the distress may be worthwhile as the cancer can be treated. But what if it is a false positive and the woman concerned goes through invasive procedures and an anxious few weeks before she is told it was a benign condition? What effect does the stress have on her health? Is it possible that the risks outweigh the advantages for many people and shouldn’t we be provided with as much information about the downside as well?
The author believes that patients should be given all the information they need to make informed choices about their treatment. They should not be worried about whether their doctor is going to make money out of their treatment. Most doctors are ethical in what they do and genuinely want to provide the best possible treatment for their patients regardless of cost. Government targets to do with not smoking, drinking alcohol in moderation, losing weight etc can overshadow every doctor patient consultation often to the detriment of the patient. Preventive medicine and screening the worried well is fine in an ideal world but when resources are limited most money should be spent on those who are sick and who have illnesses and conditions which need treating.
I was surprised to read about the effects of the two week referral window for suspected cancer cases. According to analysis of cases it seems that fewer cases are picked up from the two week urgent referrals than there are picked up from the eighteen week routine referrals. Doctors have even had it suggested to them that they should refer all cases through the two week process. The reason for these results are complex and partly related to the fact that the human body can only produce a certain number of symptoms and there may be common to several serious conditions and a much larger number of trivial conditions. It is impossible for doctors to decide which is which without further testing but they have to make some sort of judgement before they can refer their patients for further testing. This is putting the cart before the horse in my opinion.
This well written and interesting book will make you questions whether the NHS has got its priorities right. There are plenty of references to the sources of the facts and figures the author quotes in the text and an index. Maybe the NHS should stop spending large chunks of its money on the worried well and on people who have no symptoms of serious illness but who might have in the future. Isn’t it better to spend the money on the people who need treatment rather than force feeding people statins which might protect some people – no one knows which people – from heart attacks and strokes in future? Healthcare should be for the sick and not for the worried well and it should not be about targets.
October 28, 2012
Excellent discussion of how priorities have been distorted in the provision of healthcare by the clamour of the middle classes and the various vested interests of govt, pharmaceutical cos, commercial healthcare providers, and charities with a narrow focus. Testing those with no symptoms, very often without good outcomes, is stealing resources from the treatment of sick people.
September 9, 2012
Challenges established trends and accepted truths with hard evidence and profound common sense. Changed my practice; especially my views on screening.
Want to read
November 28, 2014Stumbled on via Twitter
August 17, 2017
Excellent book and easy to read. Challenges things we never thought could be challenged. Very informative.
March 5, 2019
As an allied health professional, and obviously a "consumer" of medical care myself I was riveted by this book. Dr McCartney sensibly debates the issues surrounding medicines prescribed when someone isn't ill but used as an alleged "preventative." She also tackles a wide range of other issues including the truth about screening (prostate, breast, cervical cancer etc). She presents some alarming and illuminating statistics and make sense of them for us as lay people not au fait with statistical analysis and it makes for very interesting reading.
No one can make informed decisions about their health unless they are properly informed and this book really fills the gap in that knowledge. I will be reading it again to absorb the contents more fully but it's certainly made me sit up and think about both my own practice as an AHP and my behaviour as a consumer visiting my doctor.
Great read - highly recommend it for anyone who wants to get to the truth and make properly informed decisions about attending screening and taking medicines.
No one can make informed decisions about their health unless they are properly informed and this book really fills the gap in that knowledge. I will be reading it again to absorb the contents more fully but it's certainly made me sit up and think about both my own practice as an AHP and my behaviour as a consumer visiting my doctor.
Great read - highly recommend it for anyone who wants to get to the truth and make properly informed decisions about attending screening and taking medicines.
Displaying 1 - 15 of 15 reviews