Leader: Doctors owe it to their patients to be honest

YOU WOULD need quite a bedside manner to pull this one off. "I'm sorry, Mrs Jones, there is a treatment which could postpone the onset of your ovarian cancer, but it costs pounds 4,000 and I am not allowed to prescribe it on the National Health Service." Everyone knows that this would be an honest description of the reality of the rationing of health care, but should doctors be so direct with their patients? Particularly when the brutal corollary is: "So if you can't afford to go private, you can't have the treatment."

If a doctor knows that a patient could not afford to pay for an expensive drug themselves, would it not be better to be "paternalistic" - as a distinguished cancer specialist puts it in our news pages today - and pretend there is no treatment for their condition? Of course not, and it is curious that it should take the cold logic of the solicitors consulted by the Royal Surrey Hospital NHS Trust to tell the doctors what they should already know.

The lawyers have advised the hospital that its doctors should always be entirely honest and open with patients about their treatment and the financial constraints upon it. On the narrow legal grounds of avoiding action for negligence, honesty is the best policy. But it is the best policy for the patient and for the country as a whole too.

Fortunately, lying to patients is not the only "paternalistic" attitude of the medical profession which is on the way out. Doctors increasingly accept that they and they alone cannot decide who gets which drugs - that there is a role for the Government acting on behalf of the community as a whole.

The recent dust-up between the doctors and the Government over Viagra, the anti-impotence drug, illustrated this well. The British Medical Association initially took the impossiblist position of insisting that any patient whose doctor prescribed Viagra should get it and Frank Dobson should pay. But who is to decide that Viagra is more important than the cancer drugs on which we report today?

The BMA's annual conference in Belfast today seems likely to take a more sensible view, which is that openness is the best way to encourage informed public debate, which is itself the only legitimate way to put pressure on the Government for more spending on the NHS. But Mr Dobson should be under no illusion: if all NHS trusts took the same line as Surrey County, the outcry over hundreds of hard cases would be bound to put immense pressure on the NHS budget, even with the additional pounds 20bn of spending over this and the next two years. Of course, many of the expensive new "miracle" drugs are not "cures" - what they do is help improve the odds of survival in the lottery of cancer. But there can be little doubt that access to many of them should not depend on private means.