Learning From Patients

Cultural revolution

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7402.1304 (Published 12 June 2003) Cite this as: BMJ 2003;326:1304
  1. Patrick Pietroni, head, Regional Education Support Unit1,
  2. Fedelma Winkler (fedelma.winkler@4ps.com), director, 4Ps Development Centre,
  3. Lindsey Graham, director, 4Ps Development Centre1
  1. 1 Courtfield House, St Charles Hospital, London W10 6DZ
  1. Correspondence to: F Winkler

    The UK government wants doctors to take on board patients' views in shaping practice. But how can you change the mindset of the medical profession in order to do that?

    Involving patients and the public in health care has been government policy for at least 30 years. This has, however, been left to develop, or not, in a haphazard manner, and exactly what “involving the patient” (let alone “the public”) means has never been adequately defined. This shift in policy in the NHS has mirrored the major societal trends over the past 60 years or so (see box).

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    Notwithstanding the many excellent attempts by individual doctors to engage with patients in a more cooperative manner, little progress has been made. The fundamental shift required in moving from an “expert doctor” centred model to one focused on patients' needs is a long way away. Patients may indeed be wanting to have a say in their care, but the ensuing conversation is often more like a shouting match than an orderly discussion where each side respects the skills, needs, and status of the other.

    Preparing Professionals for Partnership with the Public (4Ps)

    The 4Ps Development Centre provides tailor made educational programmes to help healthcare professionals involve patients and the public. It grew out of work at the Department of Postgraduate General Practice in North West Thames region. Professor Pietroni asked a team of clinicians and managers to explore how patient and public involvement could be systematically translated from theory into practice. The group began work by asking healthcare professionals what patient and public involvement meant to them. They found that some were mystified, many were antagonistic, and others would “do it when we have time.” There was also a dismissive group who felt they did it already.

    Major societal trends over past 60 years

    • Loss of deference towards figures in authority

    • Knowledge explosion through popular …

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