Dr. John O'Brien:

I refer to the Chairman's comments about the pill for every ill. One of the things that worries me is hearing people talk about the worried well. Since when were the well worried? I think people do have an expectation of medicine and what it can do for them which is perhaps not exactly what medicine can do. As part of their relationship and dialogue with their GPs some of this can be thrashed out, although I am back again to the issue of time. We spoke earlier about issues that arise out of advertising, specifically the advertising of medication but there are even campaigns such as those I have heard on the radio asking listeners whether they could have cancer or heart disease or suggesting colonoscopies. This can be driven by marketing and advertising, but equally I think there is a national admiration for what medicine can do, and rightly so. However, perhaps that admiration goes a little too far in terms of what it actually delivers because what it does not say is that medicine can do this but there is a cost. It is a question of that balance between the benefits that people will accrue from various interventions and the cost to them of all that. Going back again to the business, we were talking about the advertising of medications on the television and radio - on the radio anyway. I was away recently and listened to CNN for two hours, and in that two hours there were separate advertisements for 12 different medications and one for colonoscopies. I do not know that that is a wonderful place for us to be going; I think we need to back away.

Lastly, when people get to the back end of their lives, very often they are on a great deal of medication and have had a great deal of intervention. Whether further intervention, or even the medications they are already taking, is appropriate for their care and what their care will be at the end of their lives are questions that need to be planned with them. They need to have those kinds of discussions with their GPs and that is not happening because of lack of time. The net effect is that people who really should not be in emergency departments are ending up there. This is inappropriate care and goes back to a wider exposition of the Chairman's comments on a pill for every ill.