Intended for healthcare professionals


The patients who decide what makes a good doctor

BMJ 2018; 361 doi: (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”

Clinicians are patients too

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:
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.

29 May 2018
Eugene Y.H. Yeung
Lancaster, UK