Intended for healthcare professionals

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Analysis Essay

Patient power needs to be built on strong intellectual foundations: an essay by Nigel Crisp

BMJ 2012; 345 doi: (Published 21 September 2012) Cite this as: BMJ 2012;345:e6177

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Re: Patient power needs to be built on strong intellectual foundations: an essay by Nigel Crisp

Perhaps the intellectual foundation on which patient power needs to be based is the practical ability to ask the right questions. Patients hand over control to doctors and other professionals by allowing them to ask questions, which includes physical examinations and tests. However when such assessments have been concluded, it is the patients’ prerogative to ask questions. This is essential if they are going to understand and consent to treatments and other actions as expected by the GMC.

Examples of such basic questions are: (i) Which actions am I expected to agree to? (ii) For each of these actions, what is the (probable) diagnosis? (iii) For each diagnosis, what is the evidence (how it presented, was supported and its progress monitored)? Reticent patients could carry a card containing these questions to show to doctors. If the patient is seen by another doctor (perhaps for a second opinion) then he or she can pass on this information as a helpful, traditional ‘past medical history’.

The process can be helped by providing a large number of example answers to such questions [1]. Suitable computer software or modifications to existing GP systems could also allow this to be done in writing by using standard text explanations. If patients can interact with doctors and other professionals in this way, they will not only be active participants in their care but will also help raise and maintain professional standards by making everyone reason in a more transparent way.


1. Llewelyn H, Ang AH, Lewis K, Abdullah A. The Oxford handbook of clinical diagnosis. 2nd ed. Oxford University Press, 2009.

Competing interests: No competing interests

09 October 2012
Huw Llewelyn
General physician and endocrinologist, Hon Fellow
Aberystwyth University
Aberystwyth, Ceredigion, SY23 3BZ