Letters

Partnership with patients

BMJ 2000; 320 doi: http://dx.doi.org/10.1136/bmj.320.7227.117 (Published 08 January 2000) Cite this as: BMJ 2000;320:117

Treat patients as you would like to be treated yourself

  1. Otto P Bleker, head
  1. Department of Obstetrics and Gynaecology, Academic Medical Centre Amsterdam, PO Box 22700, 1100 DE Amsterdam, Netherlands
  2. Newcastle Community Development in Health, Newcastle upon Tyne, NE2 4PS
  3. University of Newcastle, Medical School, Newcastle upon Tyne, NE2 4EH
  4. Winterbourne Therapeutic Community, Reading GR7 3UE
  5. Police Hospital, 13511 Cairo, Egypt
  6. Parkgate Health Centre, Darlington D11 5LW
  7. City Hospital Nottingham, Nottingham NG5 1PB
  8. Killin, Perthshire FK21 8TG
  9. Hemsby Medical Centre, Norfolk NR29 4EW

    EDITOR—Patients today are different from patients in the past. Well informed patients want your knowledge, your listening, your analysis, your opinion, but not your decision. Luckily, you need not be the all-knowing doctor of the past. You discuss and reflect and you enable patients to reach a decision on how to face the future. The atmosphere of the consultation should be calm, gentle, and respectful.

    If possible, meet patients in the waiting room and invite them into your room. In general, you should encourage them to bring a partner or friend. The discussion may be serious, and at home the partner or friend might help in reconsidering the content of the consultation. Be aware that patients lose their autonomy when visiting a doctor. One of your duties is to try to restore that autonomy.

    Always apologise if you are late and therefore in a hurry. If you have not read the notes explain that you have not been able to read the medical notes yet. You will find that then a small miracle happens: patients will not be dissatisfied but will help you to discover why they are visiting you.

    Patients have waited for you. The art of consultation is to devote all your time and attention to them and nothing else. In general, don't take bleepers with you and don't answer telephone calls. If a bleeper goes off, a telephone call comes through, or someone storms into your room, always ask patients for their permission to deal with these intrusions and promise to make it very short. The time of the consultation is the patients, not yours.

    Generally, it is not wise to reach a diagnosis, offer treatment, and come to a decision in the one consultation. Patients need time for reflection and discussion at home.

    Consultations are an …

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