Preparing for partnership
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7402.0 (Published 12 June 2003) Cite this as: BMJ 2003;326:0
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Editor,
Have you gone mad? Soundings man! Where is it? And Minerva? What have
you done with her? The corpse of the Journal itself, of course, is only
too evident. Technicolour gore everywhere. Gone are more than 160 years
of experience in the fine art of designing the printed page (not to
mention selecting its content).
“In with the new” you say. But is it new? This issue will remind
your Australian readers of “Women’s Weekly” in the sixties. You are
elevating sensationalism to an art form, over the body of a great
tradition.
“Last Laugh”, which replaces poor Minerva, is a sad reflection on the
whole dubious enterprise. The author refers to Oliver Wendell Holmes as a
“prominent American physician” (a truth only to the ignorant). Then we are
subjected to his Parthian shot, a sadly familiar four-letter word.
Reference:
Bartrip PW. Mirror of medicine : a history of the British Medical
Journal. Oxford : Clarendon Press, 1990.
Competing interests:
None declared
Competing interests: No competing interests
Sir,
I applaud the BMJ’s ‘The Patient’ issue (14 June) and the whole
notion of allowing patients ready access to authoritative medical
information, which indeed seems likely to play an increasing role in the
co-operative model of future medicine. But do patients need a special
issue to be ‘allowed’ to participate?
I had noted that several items in this issue (pp 1284 x2; 1286; 1302-
3) addressed current conflicts surrounding ‘direct to consumer
advertising’, and also that the BMJ was offering to supply an extra
‘waiting room’ copy of this issue, for a fee. This seemed anomalous given
that this issue, as usual, contained advertisements for various
prescription-only drugs.
Richard Smith now points out that ‘waiting room’ and other copies
intended for lay audiences will not contain pharmaceutical advertising, so
avoiding conflict with current rules. However, does not the need for such
manoeuvres suggest an inherent conflict with, and a major barrier to, such
bold initiatives in information-sharing in future?
Sheena Meredith MB BS
Medical ethicist
Reading.
Competing interests:
None declared
Competing interests: No competing interests
I'm sorry that we didn't make clear that all the copies of the
Patients' Issue of the BMJ that were distributed to patients'
organisations, members of parliament, and the like did not contain any
drug advertisements. Nor do the copies that we are selling for doctors to
put in their waiting rooms.
Richard Smith, editor, BMJ
Competing interests:
I am the editor of the BMJ and accountable for all it contains and its finances.
Competing interests: No competing interests
Dear Sir
I read with interest your editorial in last weeks BMJ “The
patients Issue”. You may like to consider adding a footnote to the picture
of the naked gathering, warning them about the risks of sunburn when
participating in “outdoor naked art” as a number of people in the image
are showing signs of sunburn. Should this art movement develop momentum in
the UK it may add additional pressures on dermatological resources.
Competing interests:
None declared
Competing interests: No competing interests
The supermarket analogy continues to befuddle even the most well-
educated and intelligent brains.
Richard Smith believes supermarkets do certain things to attract more
customers while doctors--well, don't.
Apart from the fact that I find many supermarkets deeply unattractive, can
he not see the essential difference between opening all hours and offering
excellent parking or whatever at those different premises?
Supermarkets need to attract more customers to prosper.
Doctors, mostly, at least in the NHS, need to attract _less_ customers.
Most doctors are overworked, lacking the time and the energy to even
attempt a partnership with patients. The last thing they need is to add to
that load.
In my present post here in Canada I see the effects of that up close. My
colleagues are excellent GPs and patients come to them from miles away in
preference to staying with their local GPs. End result is that my
colleagues are working harder every year to keep up while increased
funding isn't much good in the face of a doctor shortage.
Yours etc
Declan Fox MB MRCGP
Competing interests:
None declared
Competing interests: No competing interests
Dear Sir,
Having read the replies to my comments. I feel I must reply.
In this kind of issue, it is always assumed that doctors have no
comprehension of what it must be like to see things from the patients
point of view.
I have been quite badly ill in the past, and have experienced the
medical system better than most would believe. I have sympathy with
patients who wish to get involved in their treatment. I have no problem
with that.
But I would not believe it appropriate for me to dictate my treatment
regime to a person who is much better qualified than me. I do not tell a
mechanic how to repair my car. The doctor-patient is not as simplistic as
that, but some in the government and in health care would like to see
that, with doctors reduced to the level of technicians. It may not seem
like that from the outside, but it certainly seems like that from the
inside.
As for the comments from Ms Teasdale, I find it particularly
insulting in suggesting that I am not suitable for medical school. I came
from
a Comprehensive school background in the North of England, got 4 A's at A-
Level and worked extremely hard through medical school to get (hopefully)
to becoming a doctor. I am not your typical medical student entrant.
In my short - oops, only six years at medical school, obviously
that's not enough when your typical undergraduate course is 3 years - time
at medical school, I have seen many patients with many terrible diseases,
and in several thousand hours of learning, while not in any way as
experienced as senior doctors, I have seen more suffering and disease than
any single person will probably see in their lifetime.
I find it sickening that the BMJ will publish a letter which resorts
to being insulting to get it's point across. It cheapens the whole of
medical journalism, and brings the reputation of medical journalism down
another notch.
It is perfectly alright for the general public to say what it likes
about the medical profession. Just don't expect us not to be annoyed about
it, and not to fight our corner.
Competing interests:
None declared
Competing interests: No competing interests
Seeing an article in the BMJ on hospital car parks prompts me to
write about something that occurred to me the last time I had reason to
visit a hospital, when I had to take my partner to our local hospital to
have her acute pneumonia treated.
After she had waited in A&E for 9 hours, she was finally admitted
and I returned to the car to go home. I had to cough up a large amount of
money for 9 hours' worth of parking charges. I couldn't help wonder what
would happen to A&E waiting times if car parking charges were paid not
by the patients' partners, but taken out of the salaries of the managers
responsible for the A&E departments.
I don't know if that counts as patient centred, but I bet A&E
waiting times would fall spectacularly.
Competing interests:
None declared
Competing interests: No competing interests
I found the patient issue thoroughly depressing. As doctor in
training, I am presented, on a daily basis, with evidence
suggesting that doctors are, variously, self-serving, arrogant, poor
communicators, unconcerned with their patients, lazy, insufficiently
expert, dangerous, negligent, in the pay of big business,
reactionary, Luddite and rude. These stereotypes are peddled by
the media and are becoming ingrained in the national psyche.
I
was disappointed to see very few (if any) contributions to the
patient issue from doctors who currently face patients in an
emergency, at unsocial hours, in dismal surroundings. These
patients present with unrealistic expectations, which have been
constantly inflated by Government spin and the gross
commercialisation of society. I feel that the patient issue merely
served to add insult to a group of healthcare workers who, in
general, are striving to provide better care every single day, in
difficult circumstances, and I was galled to have my perceived
shortcomings yet again highlighted, in a journal so closely allied to
my union/ professional organisation. It may well be that the BMA
does not actually fund the BMJ directly, but I, for one, will be asking
the Association to clarify this relationship in more detail.
A better
relationship between doctors and patients is a fantastic goal, but it
will not be advanced by sending covert messages that doctors are
always to blame when things don’t go right.
Competing interests:
I am a practicing SHO in the
NHS
Competing interests: No competing interests
dear editor,
if what you say has to be done then why not include chapters written
by patients about their views and concerns in every medical textbook so
that students can know about this so called "partnership" right from the
start.
doesnt it sound absurd.
exactly! that it is how the editors comparison between doctor
patient relationship and consumer- supermarket relationship sounded.among
many reasons why this comparison doesnt work a few things that come to my
mind immediately are
1. no supermarket owner rushes to open the
supermarket in the middle of the night to serve the customer like a doctor
does when needed by a patient.
2.a patient comes once in while to hospital whereas the staff working
there have to come daily.
medical literature and literature for the patients should be dealt
with separately in order to prevent misinterpretation and confusions. the
patients and their carers have already adequate forums to air their
concerns and view points.
Competing interests:
None declared
Competing interests: No competing interests
RELATIONSHIPS ARE KEY
Dear Editor,
I enjoyed “the patient issue” of BMJ (No. 7402, 14 June, 2003), and
share your hope for a time when the Journal might publish in partnership
with citizens.
Many of the articles, not least those from clinicians with experience
of long-term conditions, stimulated me. This highlights the oft-adopted
simplistic approach that there are “patients” and “doctors”, as if they
are from two different planets.
There is, in fact, a contradiction between calls for a “patient-
centred” approach and those for partnership. Virtually all the best
clinical practice involves partnership working between clinicians and
patients, with both reaching a concordance and then accepting their
distinct responsibilities.
In this context, a patient-centred approach makes as little sense as
a doctor-centred approach. Not only will it have an imbalance of
responsibilities, but also it limits effectiveness. Perhaps most
importantly, it implies that the clinician is less important than the
patient – a mirror image of the way in which many patients have been
treated dismissively by some doctors in the past.
The articles in “the patient edition” indicate different views about
which direction doctor-patient relationships should develop. There is a
strong need to clarify what such relationships might look like. It is
critical to ensure that we do not seek a single “ideal” relationship, but
instead establish key principles on which patients and clinicians can
develop individual relationships that maximise mutual benefit. Such
principles might include seeking an optimal balance of control and having
equitable accountability.
A true partnership focuses on the quality and appropriateness of the
relationship between the people involved. Thus, for example, short-term
contact might stress professional accountability to me as a consumer – if
I break my arm, I look to the professional expertise of the clinician to
listen to me but then to take appropriate action. A long-term situation,
however, might lean towards guided self-management – professional support
to me as an expert citizen – if I have had arthritis for 20 years, I have
the experience and knowledge to make most decisions, upon some of which I
will wish to seek professional advice.
I look forward to the day when it is considered normal to have
relationships based on mutual respect and responsibility between citizens
holding professional and lay expertise. Perhaps lay people may even be
described as people or citizens rather than as patients? Moreover, maybe
we can consider more seriously the place of unpaid carers, who provide
most health care to others.
Competing interests:
None declared
Competing interests: No competing interests