Patient centred diagnosis: sharing diagnostic decisions with patients in clinical practice

The deepening health crisis promotes the Chinese government to launch a new round of healthcare reform. On October 18th, the 19th Party Congress of the Communist Party of China explicitly stated that China was focusing on constructing the system of primary health care and general practitioners (GPs) education(1). It means that in the next five years or so, GPs in China would increase rapidly in number, and become an important part in the whole medical service system. However, GPs’ status in the eyes of the masses cannot be equaled to that of the specialists in comprehensive hospitals. For example, according to the national statistics, the average number of patients visiting in primary care institutions in 2016 was 4716.6, accounting for only 1/24 of that of comprehensive hospitals (2).

Berger’s viewpoints and case analysis of shared diagnostic decisions with patients have an important implication for GPs in China on improving the quality of primary care and earning patients trust(3). Compared with specialists in comprehensive hospitals, there are three advantages for GPs in China to make shared diagnostic decisions. First, the intrinsic characteristics of primary health care entail that GPs should fully considerate the problems before making definitive decisions. In order to ensure the comprehensiveness of the information from the patients, GPs need to adopt an open and equal attitude when communicating with the patients, listening to their complaints from physical, social and emotional ways. Second, since a majority of basic-level hospitals in China have a limited number of patient visits, GPs own more time to analyze and diagnose the diseases. They could find out the potential health risks of the patients through detailed medical history enquiry and careful physical examination, and avoid making imprudent diagnosis due to over-reliant on the medical instruments. Third, GPs can provide regular health service for the patients signed with them, and frequent interaction is helpful in establishing more stable social connection between doctors and patients. In general, patients tend to discuss their conditions with doctors who they are familiar with, express their opinions on the symptoms and examination, and comply with the decisions they made together (4).

Shared diagnostic decisions can advance the desired outcomes identified by the patients, as Berger mentioned (3), but its realization depends on the joint development of medical personnel and the system. On the one hand, medical administrations should emphasize on motivating GPs to make shared diagnostic decisions, such as introducing alternative payment plans to discourage the episodic care. On the other hand, GPs in China should take positive attitudes towards their professionalism, and keep improving their academic level. Thus the masses will gradually realize that the GPs’ diagnostic ability is no worse than specialists.

1 Xinhua News Agency. Xi Jinping’s report on 19th Party Congress of the Communist Party of China. 2017. http://news.xinhuanet.com/politics/19cpcnc/2017-10/27/c_1121867529.htm.
2 National Health and Family Planning Commission of the People's Republic of China. 2016 national development statistical bulletin of Health and Family Planning. 2017. http://www.moh.gov.cn/guihuaxxs/s10748/201708/d82fa7141696407abb4ef764f3....
3 Berger ZD, Brito JP, Ospina NS, et al. Patient centred diagnosis: sharing diagnostic decisions with patients in clinical practice. BMJ 2017, 359: j4218 doi: https://doi.org/10.1136/bmj.j4218 pmid: 29092826
4 Polinski JM, Kesselheim AS, Frolkis JP, et al. A matter of trust: patient barriers to primary medication adherence. Health Educ Res 2014, 29(5):755-763 doi: 10.1093/her/cyu023 pmid: 24838119.