The patients who decide what makes a good doctorBMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1829 (Published 27 April 2018) Cite this as: BMJ 2018;361:k1829
Opinion: The patient’s role in medical education extends well beyond being “clinical material”
All rapid responses
I am usually pleased to see an additional marker in my OSCE stations. It may allow my marks to be more objectively scored, rather than solely based on one single marker’s assessment. However, I am concerned to hear how this article justifies the reasons to have patients as markers.<1> For instance, the article states, “Once you start to think about who the healthcare system is for, it is obvious that it is the patients who should be deciding what the standard for doctors should be.” Would this approach make our future clinicians focus on customer satisfaction more than clinical judgment? A recent BMJ article discussed problems of customer expectation in clinical settings, such as a clinician being called "rubbish" for refusing to prescribe antibiotics.<2, 3> Similarly, the BMJ reported a hospital granting the parents of a child patient’s request to have care delivered only by a white doctor.<4> If we do not have clear regulations on how patients mark the students, I am afraid OSCEs can become a popularity contest, rather than a fair evaluation of future clinicians.
The article claims that medical education is moving to the next level by having patient involvement. <1> However, the article seems to ignore the fact that many clinicians have also been patients, who have encountered GPs, nurses, and pharmacists when they are ill. Clinicians can also evaluate who are good communicators to patients. In addition, professional organisations regulate clinicians and would not allow unprofessional behaviour during their OSCE markings. I welcome the idea of having patients to be additional markers in OSCE, but would like to see more elaboration on how patient tutors are regulated on their responsibility and accountability to be markers.
1. Wilkinson E. The patients who decide what makes a good doctor. BMJ. 2018;361:k1829.
2. Rosen R. Professional judgment v customer expectations. BMJ. 2018;360:k1366.
3. Is the customer always right? London, UK: BMJ; 2018 Apr 7; cited [May 2, 2018]. Available from: https://www.bmj.com/content/360/bmj.k1366/rr-0.
4. Moghal N. Allowing patients to choose the ethnicity of attending doctors is institutional racism. BMJ. 2014;348:g265.
Competing interests: I have been paid for working as a physician and pharmacist, but not writing this letter.
As a current UK medical student undertaking regular academic assessments such as the objective structured clinical examinations (OSCEs) I understand the importance of patients being involved with the marking. Throughout my training, I am taught about good communication skills in listening and responding to a patient's concerns. Hence, it is reasonable to appreciate that patients or simulated patients in OSCE stations have a role in our overall mark.
Consequently, I am not surprised at this practice being implemented at multiple medical schools across the country. It was interesting to read about the advancement of patients influencing curriculum and assessments at the university of Oxford, with a 50/50 mark scheme between clinician managers and patients (1). The example with a patient noticing the doctor grinning during the consultation demonstrates an aspect which a clinical examiner may not identify. However, I would argue that a 50/50 mark scheme may have a negative effect on future doctors. For example, a doctor may impress the patient yet be a cause of decreased patient safety due to significant gaps in clinical knowledge that are masked by exceptional communication skills.
As a medical student, it is not difficult to notice the difference in medical practice between older experienced consultants and newly qualified doctors. The understanding of patients as more than just a hospital number or a diagnosis empowers them and allows doctors to treat them in a holistic manner. This is extremely important in an age where patients are becoming more educated with the easy access of informational technologies.
My training has taught me to listen and respect periods of silences with patients, whilst addressing their concerns in addition to applying good clinical knowledge to find solutions to their problems. It is for this reason that I believe involving patients in medical education and assessments will lead to the development of the ideal doctor.
The future of medical practice is most definitely shifting towards an open consultation where the patient's views should be understood and appreciated rather than a one sided conversation with the doctor dominating. Indeed, a good doctor is one who has competent clinical knowledge and impressive communication skills, not the bad doctor who is only experienced in one aspect either knowledge or communication.
1. Wilkinson E. The patients who decide what makes a good doctor. BMJ. 2018;:k1829.
Competing interests: No competing interests