Preparing for partnership

Doctors don't like the idea that they don't put patients first—that they aren't “patient centred” in current jargon. Many doctors, particularly older ones, have sacrificed hundreds of nights' sleep, their health, and even their families to the care of patients. How can they not be “patient centred”?

The answer is that being patient centred involves much more than being dedicated and caring. It's a different way of thinking and behaving, where doctors and patients work together as true partners. Neither side finds it easy. This theme issue explores what a true partnership means and looks forward to a time when the BMJ itself—very much the property of doctors for its first 160 years—might publish in partnership with patients.

Two images illustrate how doctors are not patient centred. The first is the hospital car park, always a political battleground. Can anybody imagine a supermarket car park where customers have to walk past the cars of the staff in order to buy? But that's normal in hospitals. The second image is a letter about a patient. Do you like the idea that A might be writing a private letter to B about you, supposedly on your behalf, in language that you can't understand? You don't, but that's what doctors have been doing for centuries.

Medical journals have been no better. As recently as 10 years ago it was normal to publish pictures of patients stark naked without their consent. Patients have been objects in medical journals not partners. Very few editorial boards include patients, and most medical journals publish no material whatsoever from patients. They are written about. Their voices are not heard.

We are trying to change that, but it's not easy. Editors like to think that medical journals can lead not just follow, but medical journals are behind medicine in patient partnership. There are doctors who work in a true partnership with patients, but there are no journals that do. Most have never even thought about it.

The BMJ took a first tentative step towards partnership with patients by including a patient when we created an editorial board in 1997. A few years ago we adopted a strategic objective of trying to include patients' voices more in the BMJ, and for the past two years the whole BMJ Publishing Group has begun preparing for a world where doctors and patients work in partnership. One consequence is that we have produced a website, Best Treatments, that reaches doctors and patients simultaneously. Currently, for business reasons, this is available only in the United States, but we hope to make it more widely available.

The BMJ itself has appointed a patient editor, Mary Baker, and we will later this year be having the first meeting of a patient advisory board. Patient voices are being heard more regularly in the BMJ—for example, in our interactive case histories. This theme issue—edited with energy and flair by Lynn Eaton—Is another step towards genuine patient partnership. The aim is not to turn the BMJ into a publication for patients (although that could happen in the longer term) but rather to help doctors prepare for a world where true partnership with patients is the norm.