Intended for healthcare professionals


Patients’ actual care pathways often differ markedly from doctors’ perceptions

BMJ 2013; 347 doi: (Published 08 November 2013) Cite this as: BMJ 2013;347:f6728
  1. Nigel Hawkes
  1. 1London

Seeing care through the eyes of patients is demanding and sometimes demoralising to clinicians, a conference at the King’s Fund in London on 6 November heard.

The clinician’s idealised view of the patient’s care pathway had little in common with the actual experience of patients, especially those with a chronic illness, whose pathway typically involved occasional brief encounters with clinicians separated by many days and weeks, speakers said.

Even acute interventions that cured a patient’s illness could consist of more sandwich than filling. At Alder Hey Children’s Hospital in Liverpool, the doctors Joanne Minford and Julie Grice looked at the care received by children with abdominal pain.

“We’d been quite complacent,” Minford admitted. “We believed we always put the child first.” But observation of actual patients showed that waits were long, care was inconsistent, diagnoses were delayed, and many admissions were unnecessary.

One patient was shadowed from her arrival at Alder Hey, after a GP appointment first thing in the morning and a referral to a district general hospital. She was finally …

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