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EDITORIALS: Paul D Cleary The increasing importance of patient surveys BMJ 1999; 319: 720-721 [Full text]

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Public attitudes may be hard to handle

Aldo Mariotto   (21 September 1999)

Public attitudes may be hard to handle 21 September 1999
Aldo Mariotto Head, Unit for Technology Assessment and Quality Assurance, Local Health Unit n. 16, Padua, Italy Send response to journal: Re: Public attitudes may be hard to handle	One can only agree with the editorial "The increasing importance of patient surveys" published in BMJ 1999; 319: 720-721 (1), which emphasizes a number of very important steps ahead. It is finally being understood that public involvement must encompass fundamental issues and not merely restrict attention to whether the waiting room is too cold or too hot, whether the nurse has been too friendly in her method of address, or whether her personal badge was clearly recognizable. While rigorous, sophisticated methodologies are currently available to assess patient opinions, progress is still warranted with regards to explained variance and, more generally, the explanatory power of survey results. This may perhaps depend on the fact that good research in this field is in its infancy and that the variables in play have not yet been sufficiently studied. Patient surveys hold great creative potential for health facilities and may aid health directors in coping with overhanging clouds, supported by the comforting feeling that they are acting in agreement with users, as raised in correspondence in the eBMJ (2). In some cases, however, intervention by the general population may present intriguing legal and moral aspects or, in short, be hard to handle. For example, the results have recently been published of a survey where elderly people resident in an Italian city were asked whether they believed it was right for them to give up their place in the queue for cardiac services so that younger or self-employed people might have faster access to hospital (3). About half of the respondents deemed it right to give up their place for cardiac surgery to a young (51%) or self-employed person (47%). Percentages were significantly higher for outpatient consultation. The results of the survey were objectively surprising and will naturally not be easy to deal with because of their implications in the debate on ageism or antiageism. The issues raised are perhaps greater than those that can be solved over a short period of time. Nonetheless, hiding the truth is not the best method of facing the challenge posed by public attitudes. Modern health facilities must instead prepare themselves to deal with increasingly complex problems, which will require reorientation of health services with appropriate management, legislation and resources. References 1. Cleary PD. The increasing importance of patient surveys. BMJ 1999; 319: 720-721. 2. Web extra. Patients as partners? eBMJ 1999; 318 www.bmj.com/cgi/content/full/318/7186DC1 (accessed 1 September 1999). 3. Mariotto A, De Leo D, Dello Buono M, Favaretti C, Austin P, Naylor CD Will elderly patients stand aside for younger patients in the queue for cardiac services? Lancet 1999; 354: 467-70.