Disputed diagnoses: the cases of RSI and childhood cancer

Recently, greater emphasis has been accorded lay views and involvement in d ebates on health care provision. At the macro level, policy makers are urge d to take heed of the opinions of the general public when formulating new p olicies for health care or making changes to existing ones. Furthermore, it is suggested that this accommodation should be repeated at the level of th e individual, namely in encounters between doctors and patients. However, i mbalances in the doctor-patient power relationship, compounded by structura l barriers, can create problems which prevent this sort of collaborative in teraction from taking place. Against this background, the paper draws on ev idence from studies of two quite different conditions, repetitive strain in jury (RSI) and childhood cancer, to explore lay perspectives and empowermen t in relation to obtaining a diagnosis. The findings of the studies are scr utinised in respect of four related areas of concern: how much lay views co unt, exercising choice, referral pathways and the withdrawal of trust from medical practitioners. The evidence suggests that a substantial number of p atients with RSI and parents of children with cancer felt their experiences and knowledge were disregarded by doctors in the diagnostic process. Denyi ng the validity of an individual's perceptions had implications for obtaini ng an accurate diagnosis, which could in turn make access to appropriate he alth care and treatment problematic. Their experiences led some people with RSI to show a general distrust of medicine; this was less the case for par ents of children with cancer. A key issue to emerge from the analysis is th e need for additional training in two areas of the medical curriculum: comm unication skills and occupational health problems. The underlying problems of attitudes especially giving weight to the informed views of lay people, is another matter which needs to be addressed. (C) 1999 Elsevier Science Lt d. All rights reserved.