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Patients: the final frontier

BMJ 2013; 346 doi: (Published 02 April 2013) Cite this as: BMJ 2013;346:f2075
  1. Edward Davies, US news and features editor, BMJ
  1. edavies{at}

Some days, the worst thing about being a doctor is the patients. In theory, presented with a distressed member of the public, the physician can conjure a masterful diagnosis, fathom an ideal treatment, and generate the perfect outcome.

Round table on patient participation

But somehow, between that consultation and outcome, things can go awry. From ignored instructions to discontinued prescriptions, people can often get in the way of medicine. And it’s because of this that some physicians have woken up to the importance of patient engagement in recent years—the finest doctor in the world can do nothing with a patient who won’t listen.

Last week the BMJ held its annual editorial board meeting and used the time to conduct a round table discussion on what is going on in this field and what needs to be going on. The resulting podcast lays out the problem very clearly (

Brian Haynes, from McMaster University’s Department of Clinical Epidemiology, says that patient participation is central to all medical practice.

“It’s the key barrier to the success of evidence based medicine, that patients don’t follow the treatments they are prescribed,” he offers.

“Practitioners are the last to know if patients are not following their treatment so there is obviously some aspect of sharing information that needs to be overcome. But if we are on the mission of trying to use evidence to improve healthcare, we are failing at the interface between practitioners and patients because we are not able to engage the patients in such a way as to figure out the care for themselves.”

Subjects such as patient communication and implementation research don’t perhaps have the pizzazz and allure of a cure for cancer. But in the discussion that unfolds in the podcast what becomes abundantly clear is that a working cure for warts, let alone cancer, won’t work unless patients are engaged in it, and knowledge translation research is central to this.

“If we don’t do implementation research, we should shut off all research—we’re wasting our money doing it,” says Hayes. He’s probably right.


Cite this as: BMJ 2013;346:f2075


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