Sometimes, too much choice can be bad for your health

This is a story about a snakebite that reveals something about medicine, and something about international health systems, that the Tories think we should learn from, but Labour thinks we can better. It was told to me by my cousin, a public-health specialist in the US government, who lives near Washington, DC. Her daughter was mountain-biking in the wilderness of Colorado with a male friend and his dog. A rattlesnake bit first the dog and then the male friend. With difficulty, they made it back to civilisation and summoned help.

This is a story about a snakebite that reveals something about medicine, and something about international health systems, that the Tories think we should learn from, but Labour thinks we can better. It was told to me by my cousin, a public-health specialist in the US government, who lives near Washington, DC. Her daughter was mountain-biking in the wilderness of Colorado with a male friend and his dog. A rattlesnake bit first the dog and then the male friend. With difficulty, they made it back to civilisation and summoned help.

Two ambulances were dispatched, one for each victim, but only the dog was given an injection of anti-venom, because doctors have learnt that anti-venom can provoke a severe allergic reaction that has on occasion proved fatal. The treatment can be worse than the disease.

The standard approach to snakebites in the US now is therefore watchful waiting – for human victims. Animals are given rapid relief from their suffering.

So, while the dog recovered in hours, the man was left in agony while his leg swelled to several times its normal size. A nurse checked it every 15 minutes with a measuring-tape as it ballooned in front of his eyes. It took a month to go down.

So did the dog receive the better care? As it happened in the US, the doctors will have felt the hot breath of the medical-negligence lawyers on their necks. But it is a nice question how one balances certain and lengthy discomfort and disability against the small risk of a deadly reaction. Whose choice should that be?

Medical negligence plays strongly in the US, but it is growing here, too. Last week, the National Audit Office highlighted the £500,000 rise in the potential cost of awards in the pipeline in the past year, bringing the total bill facing the NHS to £4.4bn. Yet cross the Channel to France, and there is virtually no medical-negligence bill. Patients don't sue in France. The public hospitals are subject to public law, and patients are not well protected. If something goes wrong in a private hospital, it is possible to sue – but the labyrinthine French legal system does not make it easy, and the system is not generous.

Here, then, is a virtue of the French health system that the UK would do well to copy. But we cannot turn the clock back to a time when patients accepted what their doctors told them without question and suffered errors without complaint. For the French attitude to doctors is antiquated and paternalistic. We need a better way of dealing with medical negligence – and the Government's chief medical officer, Liam Donaldson, is looking at options – but it is not the French way.

One advantage the French system does have is patient choice. French citizens are free to choose their doctors – and if the doctors don't deliver what they want, they choose another. So satisfaction is high.

But there is a price. The French do not believe that suffering is the body's way of dealing with illness, that it is a natural process that must be allowed to run its course and that often the best treatment is watchful waiting. They want whatever modern medicine can offer, and they want it now.

The consequence is that the drugs bill has rocketed in France, with a 70 per cent increase in consumption in the past decade. In France, 90 per cent of women in childbirth have epidurals – why put up with the pain if there is a way around it? About 40 per cent of the population take tranquillisers to get them through the day. The rise in the drugs bill is threatening the funding of the GP service. Judgements about health often come back to that delicate balance between what is available and what people need. Sometimes what is available – anti-venom for snakebites; tranquillisers for stress – is not good for all patients. Giving patients a choice will have a downside. Healthcare that is too accessible can be as damaging as healthcare that is inaccessible.

That is why I do not share the view of those who think it a disgrace that we will have to wait until 2020 in Britain for a world-class health service with, in the Government's vision outlined in its Budget-day report on the health service, two-week waiting-lists for in-patient treatment, compared with a maximum of 15 months now.

Two weeks? That is hardly long enough to pack a toothbrush and put a note out for the milkman. People need time to weigh up the pros and cons before submitting to the surgeon's knife. Perhaps drugs would be just as good. Perhaps, on reflection, that operation is not essential.

Time is a great healer, and medicine delivered too promptly can do more harm than good. Watchful waiting is often the best prescription. We shall be doing plenty of that over the next 20 years.