Published 6 November 2008, doi:10.1136/bmj.a2431
Cite this as: BMJ 2008;337:a2431

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Patients are ready for partnership

Why are we still so bad at providing patients with information? Despite the best efforts of some health professionals, communication is often patchy, many questions are never asked for want of an opportunity or for fear of appearing demanding, and answers can be contradictory and confusing. As a result, patients and their families are all too often cast as supplicants, scrabbling for crumbs from medicine’s high table. All of which stands in the way of their ability to understand what’s happening and to be active in decisions about their health. How could we do better?

Tessa Richards has one simple suggestion (doi:10.1136/bmj.a2324). Why don’t we copy patients in on all medical correspondence? Some doctors already do so, but according to the United Kingdom’s Healthcare Commission they are in the minority, despite clear guidance and government pledges. Results of investigations could also be shared, says Richards. "Doctors should not assume that patients won’t understand them or don’t need to know if the results are normal."

Doctors’ assumptions about what patients know or are capable of knowing may be an important barrier to sharing of information, and the impact on health can be substantial. With a four to six times increased risk of type 2 diabetes, South Asians in Europe are a group for whom prevention should be a public health priority, says Shifalika Goenka (doi:10.1136/bmj.a2010). In a qualitative study of beliefs and attitudes in London’s Bangladeshi community (doi:10.1136/bmj.a1931), Clare Grace and colleagues found that religious leaders and lay people understood that lifestyle change could prevent diabetes, and they saw no conflict with the teachings of Islam. By contrast, health professionals perceived Bangladeshis as poorly informed and fatalistic about their health.

The challenges of sharing information across language and cultural divides are huge, but they must be overcome. Health literacy is not a "nice to have" it’s a "must have." As Richards reports, low health literacy is estimated to cost the US economy between $106bn and $236bn each year.

A shift towards seeing patients more as partners than as recipients of care could be the change we need. It could advance the debate around research ethics, say Michael Goodyear and colleagues (doi:10.1136/bmj.a2128). It could also reduce errors by tackling what the Bristol enquiry called the culture of arrogance among doctors. As Jane Feinmann reports (doi:10.1136/bmj.a2370), WHO’s Safe Surgery Saves Lives initiative is promoting a simple perioperative checklist, which may soon be mandatory in the United States but is controversial in the United Kingdom. "There will always be 5-15% of mature professionals who won’t join in, including the surgeon who everyone has had to tiptoe around for years," says Tony Giddings, a former surgeon and now chair of the Alliance for Patient Safety. "Perhaps these people will need to move on."

Patients are ready for partnership. Don’t let it be doctors who hold them back.

Cite this as: BMJ 2008;337:a2431

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