Intended for healthcare professionals


Patients are important links in the healthcare chain

BMJ 1999; 319 doi: (Published 18 September 1999) Cite this as: BMJ 1999;319:787
  1. Paola Moscon, doctor in biological science (mosconi{at}
  1. Istituto di Ricerche Farmacologiche Mario Negri, Department of Oncology, Via Eritrea 62, 20157 Milan, Italy

    EDITOR—In Italy at the end of 1997 a new law was approved which streamlined the processes involved in obtaining external breast prostheses for women who have had a mastectomy. The new law was the direct result of action taken by the Italian Forum of Europa Donna, an umbrella organisation of consumer groups.

    In January 1997, the forum collected evidence on the difficulties faced by women seeking breast prostheses through the national healthcare service. The forum collected evidence from 30 different organisations throughout Italy. What the forum discovered was that the process was lengthy (involving several trips to various offices to obtain the necessary certificates and authorisation for the prosthesis) and emotionally draining. The forum also found that different procedures were followed in different parts of the country. In May 1997 the evidence was presented to the Senate, and the new law was passed in December.

    This result emphasises the idea that patients, or consumers, must play an important and fundamental part in the debate over public health because the incentive for valuable change may come from them. Patients face the problems of their illness daily and so have an excellent overview of where the system may be failing them. Consumers and their organisations are links in a complex chain of health care; the different parties must promote initiatives that allow patients to maintain their own identities and enable them to take part in their care, and services must be developed and offered in a coordinated manner.

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