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ANALYSIS: Trisha Greenhalgh Patient and public involvement in chronic illness: beyond the expert patient BMJ 2009; 338: b49 [Full text]

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Curious priority

Martin W McNicol   (13 March 2009)

Patient as a partner in care

Billy Boland   (14 March 2009)

Curious priority 13 March 2009
Martin W McNicol, retired (former physician) HU17 8HP Send response to journal: Re: Curious priority	Would it not be better if we had the patient's view first before all of the others, particularly in an issue carrying Greenhalgh's article on rethinking patient involvement? Competing interests: None declared
Patient as a partner in care 14 March 2009
Billy Boland, Consultant Psychiatrist Hertfordshire Partnership Foundation Trust, St Albans, AL1 1NG Send response to journal: Re: Patient as a partner in care	Prof Greenhalgh's analysis of lay person involvement in the management of chronic disease rightly challenges the evidence behind health policy changes from the Department of Health with the extension of expert patient programmes. However a focus on treatment efficacy diverts attention from important changes in relationship between healthcare providers and patients such programmes represent. Innovative treatment strategies including the disease management programmes highlighted in the article have promoted a new dialogue between service users and health care providers, deepening their understanding of each other. The recovery model of mental health care draws on each of the four approaches outlined by Greenhalgh of patient and public involvement. It is recognised as good practice for modern mental healthcare provision, recommended by mental health think tanks such as the Sainsbury Centre (1) and incorporated as strategy into the business plans of Mental Health Trusts. Efficacy is still being explored, but experience suggests recovery methods have benefits. Elements which involve changes in style of practice, such as a transition over the course of recovery from the practitioner as expert to practitioner as coach or mentor, may develop patients engagement with their conditions and their health service providers. Whilst efficacy may be an important outcome measure for examining chronic illness approaches, other dimensions including patient satisfaction and engagement with health services, as well as empowerment through education may be valuable if costs are limited. Improvements in these areas could develop patient's trust of services and perhaps lead to better uptake and utilisation of interventions that have more recognised efficacy. 1 Shepherd, G., Boardman, J., Slade, M., Making Recovery a Reality, Sainsbury Centre for Mental Health, 2008 Competing interests: None declared