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CLINICAL REVIEW: Kieran Walsh The gap between doctors' and patients' perceptions BMJ 2004; 329: 502 [Full text]

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The gap between doctors’ and patients’ perceptions- Is it bigger in children and adolescents?

Alka S Ahuja   (27 August 2004)

Do patients really want to collaborate ?

Francesco Carelli   (8 September 2004)

The gap between doctors’ and patients’ perceptions- Is it bigger in children and adolescents? 27 August 2004
Alka S Ahuja, Specialist Registrar in Child & Adolescent Psychiatry University Hospital of Wales, Cardiff CF14 4XN Send response to journal: Re: The gap between doctors’ and patients’ perceptions- Is it bigger in children and adolescents?	The involvement of children and adolescents in making treatment decisions poses new challenges for doctors. Recent research highlights, that increased patient involvement in health care, as a result of socio- political changes, improves health outcomes (1,2). A report by the Commission for Health Improvement suggest that children and teenagers are unhappy with the lack of communication they get when they are treated in the NHS and think that they are not sufficiently involved with the decision making process (3). The report gives examples of situations where young people feel uninvolved i.e. during referrals to other agencies, treatment decisions, accessing information about their problems etc and highlights their suggestions on improving the NHS. People’s appetite for information about treatment is often greater than doctors believe. There is a broad range of information preferences that may differ at different times and for different reasons. For young peoples’ views to be valued there must be a partnership between them and the doctors. Although some patients may not wish to make the final choice of treatment, many would prefer more information. However there appears to be another spectrum of involvement ranging from health professionals giving information to the young people to a genuine hand over of power and decision making which makes these adolescents feel more empowered and in control of their condition. Often it is unclear whether increased satisfaction arises from young peoples’ greater articulation of their expectations, or from feeling reassured that the doctor is willing to listen, or something else altogether. In order to improve quality of care we as health professionals need to understand the young people’s preferences. REFERENCES: 1. Department of Health. The expert patient: a new approach to chronic disease management for the 21st century. London: DOH, 2001. 2. Greenfield S., Kaplan S., Ware J.E. Expanding patient involvement in care. Annals of Internal Medicine 1985; 102: 520-528. 3. Odigwe C. Children say they are not involved enough in their treatment.BMJ 2004; 328: 600. Competing interests: None declared
Do patients really want to collaborate ? 8 September 2004
Francesco Carelli, EURACT Council ,National Representative - RCGP 43017 - GMC 4256757 - Lecturer University of Milan 20123- Milan - Italy Send response to journal: Re: Do patients really want to collaborate ?	General Practice is the place where most frequently doctors are better at finding out why patients come to see them. The main reason is because of the holistic and longitudinal way of approach, typical for general practice. Also, in specialists' office, patients arrive for "that" specific problem. It could be that some doctors assume that patients' first complaint is their chief one, but, really, in fact the order in which patients present their problems is often unrelated to their clinical importance. The first one, in these cases, is only the top of the iceberg. So, what to do ? Ask for longer appointment times in primary care ? ask for succesive appointments ? In Italy, patients are not paying, so following appointments could be a chance in good practice. Of course, all depend on the relationship between doctor and patient and, consequently, on patients willing to open themselves and to speak and collaborate. Another point is to give news or bad news to patients: I see that we are not enough prepared in University and during life to manage this and it depends on our willing and our skills. Also, in this case, I see that General Practitioners are the best ( also becaase obliged to do this ..nobody else willing ...) Finally, while many patients say they want more information than they receive, in fact they want to receive part ( not all )information and, usually, not for very bad news. Also, we know patients not willing to get examinations for screening, because not willing to know about bad news... Competing interests: None declared