Topics covered in this chapter

Three key points about values in medicine are outlined as illustrated by a GP consultation for chronic low back pain between Dr. Gulati and her patient, Roy Walker.

Other topics include:

• Ethical and other values

• Clinician and patient values

• Foreground and background values

• The network of values

• Values, decisions and actions

• NICE guidelines for low back pain.

Take-away message for practice

Values in medicine (i) include but are wider than ethics, (ii) are everywhere and (iii) are action-guiding.

Values-based practice, as we indicated in our introduction, is a new skills-based approach to working more effectively with complex and sometimes conflicting values in medicine. As such, values-based practice is like evidence-based practice: both are responses to the growing complexity of clinical decision-making. Evidence-based practice supports clinical decision-making where complex and sometimes conflicting evidence is in play. Values-based practice supports clinical decision-making where complex and sometimes conflicting values are in play.

In this chapter, we illustrate the complexities of values in medicine not with a high-profile “ethics case” but rather as they emerge from the everyday scenario of a GP consultation for chronic low back pain. Three key points will emerge from this scenario, namely that values in medicine:

• are wider than just ethics, which nonetheless are an important aspect of our values;

• are everywhere in medicine, although not always recognized for what they are;

• are important because they stand alongside evidence in guiding decisions and actions.