The rationing of scarce healthcare resources is a subject that is both politically sensitive and raises a number of ethical dilemmas for those charged with making treatment decisions. This paper reports findings from a study of decision making in primary care. The study aimed to describe the way in which the allocation of scarce resources is perceived and addressed implicitly and explicitly by GPs in consultations with patients.
Our starting point was the view that if patients are to participate in decision making then explicitness (in the sense that decisions, and the reasons for decisions, are clearly communicated) is a necessary prerequisite for involvement. By this it is meant that GPs have to be clear, both to themselves and their patients, about the criteria they use when engaging with a patient in decision making (Osborn, 2006). For example, if a decision is made not to give a particular treatment on the basis of cost, this would be explained to the patient.
In its summary of the conclusions and recommendations of a House of Commons report on priority setting with the NHS, the Health Committee maintained:
'We … need an honest and realistic set of explicit, well understood ethical principles at national level to guide the NHS into the next century'.
Communication Skills for Health professionals
Health communication encompasses the study and use of communication strategies to inform and influence individual and community decisions that enhance health. It links the domains of communication and health and is increasingly recognized as a necessary element of efforts to improve personal and public health (Campbell, 2008). Health communication can contribute to all aspects of disease prevention and health promotion and is relevant in a number of contexts, including health professional-patient relations, individuals' exposure to, search for, and use of health information, individuals' adherence to clinical recommendations and regimens, the construction of public health messages and campaigns, the dissemination of individual and population health risk information, that is, risk communication, images of health in the mass media and the culture at large, the education of consumers about how to gain access to the public health and health care systems, and the development of telehealth applications.
For individuals, effective health communication can help raise awareness of health risks and solutions, provide the motivation and skills needed to reduce these risks, help them find support from other people in similar situations, and affect or reinforce attitudes.1 Health communication also can increase demand for appropriate health services and decrease demand for inappropriate health services(Osborn, 2006). The practice of health communication has contributed to health promotion and disease prevention in several areas. One is the improvement of interpersonal and group interactions in clinical situations (for example, provider-patient, provider-provider, and among members of a health care team) through the training of health professionals and patients in effective communication skills.3, 4 Collaborative relationships are enhanced when all parties are capable of good communication.
Another area is the dissemination of health messages through public education campaigns ...