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BMAT Section 3 Essay Plans

Based On BMAT Essays Scoring 5A

When treating an individual patient, a physician must also think of the wider society.

Explain the reasoning behind this statement. Argue that a doctor should only consider the individual that he or she is treating at the time. With respect to medical treatment, to what extent can a patient’s interests differ from those of the wider population?

Explain the reasoning behind this statement.

  • This statement is based on the medical ethics principle of ‘justice’. A physician has a duty to all of his patients, including how to share and allocate limited resources to an increasing population of patients.

Argue that a doctor should only consider the individual that he or she is treating at the time.

  • ‘Considering wider society’ may be used as an excuse for providing suboptimal care. For example, an unethical doctor such as Dr Harold Shipman may try to justify killing approximately 200 patients by suggesting that he was thinking of broader society and reducing the strain on limited NHS resources.
  • Each patient is unique, and in another sense, considering how other patients in society may have responded to treatment following a similar presentation, may be of some use. However, patients often present atypically and respond very differently. Thus, whilst general societal guidelines can be useful, a bespoke approach should be taken into account for each patient, considering their respective co-morbidities and associated factors.

With respect to medical treatment, to what extent can a patient’s interests differ from those of the wider population?

  • For a patient with advanced cancer, it may be in their interests to receive the latest treatment, which may not be necessarily licensed by NICE due to unjustifiable cost. For example, Provenge which can be used for metastatic prostate cancer costs between £250,000 and £500,000/QALY and as such is not funded by the NHS (NICE, 2015). It would likely be in the individual’s interest to have the medication, whereas wider society cannot justify the expense when correlated with the additional life expectancy.
  • Many procedures have substantial waiting lists, for example, current NHS waiting lists for knee replacements are approximately 18 weeks (The Guardian, 2017), whereas it is likely that the patient would prefer to have the procedure as soon as possible.
  • On the other hand, it is generally in society’s interests to provide the best available medical care in the shortest time frame to preserve workforce productivity. For every day that a patient goes without a knee replacement, it may represent an additional day of income tax revenue lost by society. Similarly, not providing the cancer patient with the best chemotherapy agent would similarly shorten their life expectancy and reduce their positive societal contribution.

Conclusion
Whilst it is important for doctors to consider wider society, this should not compromise the care of the patient in front of them. Furthermore, although the broader aims of society and an individual are unified, the limited nature of resources means that in many cases, the NHS is unable to provide the complete scope of healthcare provision for individuals, especially within their desired timescale.

"When you want to know how things really work, study them when they are coming apart." (William Gibson)

Explain what this statement means. Argue to the contrary. To what extent do you agree with the assertion?

Explain what this statement means.

  • This statement suggests that physical and metaphorical dissection of an entity is required to understand its role and functionality truly.

Good surgeons should be encouraged to take on tough cases, not just safe, routine ones.

Publishing an individual surgeon’s mortality rates may have the opposite effect. Explain what this statement means. Argue to the contrary. To what extent do you think league tables should change a surgeon’s behaviour?

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