Singing fromthe same hymn sheet
.......but who is listening to the patient?
A headline in Pulse Today caught my attention recently.
“New NICE CMO says GPs and pharmacists should be ‘singing from the same hymn book’.”
At first glance, it sounds entirely logical. Most of us would probably think that this is the sensible thing to do. Medicines do not exist in isolation. A GP may prescribe them, a pharmacist may dispense them, a consultant may recommend them and another healthcare professional may monitor them. Good communication between those professionals is essential, this sounds like good patient safety practice.
Yet when I read those words, it felt wrong. Its why my family face the challenges it does.
Where is the patient in the choir? We already know what can go wrong when they are not.
Six years ago, the Independent Medicines and Medical Devices Safety Review published First Do No Harm.
It investigated what had happened to families affected by sodium valproate, pelvic mesh and hormone pregnancy tests. These were very different medical interventions, affecting different groups of people. Yet the Review found an overarching theme connecting their experiences:
“No-one is listening.”
Patients had raised concerns. Women had described symptoms. Parents had reported what was happening to their children. Families had begun to see patterns. Too often, they were not heard.
Systemic problems were identified and core changes made: the patient voice, and patient choices were championed; and patients finally felt empowered.
So what happened? Has this intention changed? What does “singing from the same hymn book” mean for the patient, after the healing of what were identified as major problems in the health care system, the work of Baroness Cumberledge and her team, the many patients that shared their stores, is this not worth examining more closely.
We have seen what happens when everyone is working from the same guidance, the same assumptions and the same accepted evidence - and something important is missing?
IMMDS showed us the possible consequences. Harm can continue and signals can be missed. Patients can spend years trying to find explanations by the time the evidence catches up, some of that harm may be irreversible. We should remind ourselves of the goals of the review seeking to listen to the patient, and give them their voice, and the ability to choose about their own health care. These are the people who will ultimately live with the consequences of any harm just as much as they may reap the benefits of good choices.
Who decides what the “right choice” is?
There was another sentence in the Pulse Today article that made me stop:
“How do we empower people to be able to support the patients to make the right choices around medicines?”
Again, it sounds entirely reasonable. But I thought who decides what the “right choice” is? It underlines the message that patients are not able to make their own decisions abut their treatment.
There is a significant difference between giving someone the information they need to make their informed choice and helping them towards a choice that has already been decided is the right one.
A decision about a medicine should involve the evidence: expected benefits, known risks, possible adverse effects, uncertainties, alternatives and the consequences of not taking it.
But it must also involve the patient, it is their body.
What matters to the patient? What risks is the patient prepared to accept? What other medicines are they taking? What other health conditions do they have? And importantly, what is actually happening to them while taking the medicine?
Sometimes there isn't one “right choice”. There are competing risks. For someone with a serious long-term condition, stopping or changing an effective medicine may itself be dangerous. Continuing a medicine that may be causing harm, this is why shared decision-making matters.
It isn't about persuading a patient to make the right choice. It is about reaching a decision with them, and respecting the patients decision.
What happens when the patient doesn't fit the hymn book?
Who sees the whole health care journey?
This leads to another question.
Who is responsible for looking at a person's medicine journey as a whole?
A pharmacist may identify an interaction. A GP may investigate a symptom. A neurologist may concentrate on seizures. A specialist may investigate the liver, kidneys, bones, heart, hormones or nervous system. Each may be doing their job correctly. But a person can have treatment for five, ten, twenty or fifty years. During that time doses change. Medicines are added and removed, interventions happen. Prescribers change. Health conditions develop. Symptoms appear. Guidance changes. Scientific knowledge changes.
Often nobody goes back to the beginning. The patient may be the only person who has travelled through that entire history. That doesn't mean the patient's interpretation will always be right. It does mean their experience contains information that should not simply be dismissed because it doesn't fit what is already known.
It is a signal worth investigating.
What did First Do No Harm actually teach us?
This is why I find these comments so interesting six years after First Do No Harm.
The Review was not simply a historical account of three medical scandals. It showed how a healthcare system can fail when the experiences of patients and families do not fit established medical thinking.
NICE itself recognises the importance of involving people in decisions about their medicines. Medicines optimisation and shared decision-making should include the person's concerns, experiences and preferences alongside clinical evidence.
Perhaps the patient shouldn't simply be handed the same hymn book as everybody else. The patient needs to be able to say:
“Something in here doesn't match what is happening to me.” somebody needs to listen.
Of course GPs and pharmacists should communicate. Of course professionals should have access to consistent, high-quality information. Fragmented healthcare creates serious risks of its own.
But medicine safety requires something more than everybody agreeing. Sometimes safety depends on somebody noticing the thing that doesn't fit.
Such as a pharmacist questioning an unusual prescription.
A GP wondering whether a new illness could actually be an adverse drug reaction.
A researcher spotting an unexpected pattern.
A clinician prepared to say, “We don't know.”
Or a patient saying:
“No. Something has changed.”
That different note shouldn't automatically be treated as noise. It may be the beginning of a safety signal. So yes, let the GP and pharmacist sing from the same hymn book. Let the consultant join them.
But make room for another voice. The patient. Not sitting silently in the congregation.
Not simply expected to follow along. But able to question what is written there. Because sometimes the patient will be wrong. Sometimes the professional will be wrong. Sometimes the hymn book itself will be wrong.
The real test of a safe healthcare system is whether we are prepared to find out.
One small factual point worth preserving: the Pulse article was published 30 July 2026 and reports comments by NICE Chief Medical Officer Dr Adrian Hayter. It includes both the “same hymn book” argument and his comments about supporting patients to make the right choices around medicines.
For the IMMDS section, First Do No Harm itself is the strongest source. Its first overarching theme is explicitly “‘No-one is listening’ – The patient voice dismissed.” The report goes further: it says the consequences of not being believed or listened to undermine an equal patient-clinician relationship and shared decision-making.
And there is an important source for your argument about the words “right choice.” NICE's own shared decision-making guidance says decisions should be reached jointly, should include risks, benefits and consequences, and should recognise that a patient's view of those trade-offs may differ from the healthcare professional's. NICE also says patient decision aids should not steer people towards one option.
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