Patients to be asked what they need from doctors
BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4690 (Published 12 July 2019) Cite this as: BMJ 2019;366:l4690
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As final year medical students, we strongly agree with the author on the importance of asking the public on their needs from us, as future practitioners. Our training is highly dependent on learning through the experiences of our tutors who each have a very different style of practicing medicine, but at times, could be considered out-dated. However, we also do understand the challenges of asking the public of their needs for the fear of developing a rigid structure which may not be suited for all patients.
Instead, we believe we should be shifting towards training medical students on the importance of treating the patient in front of them as an individual, as opposed to teaching a textbook disease or illness. In addition, some patients prefer a paternalistic approach for the fear of making decisions and the idea that their doctor knows best [1].
We believe the true way of understanding the public needs is by integrating early patient contact into the curriculums of all medical schools so that students are able to understand that one size does not fit all and to truly understand their patients needs and therefore understanding the public's needs.
[1] Cole, J., Kiriaev, O., Malpas, P. and Cheung, G. (2017). ‘Trust me, I’m a doctor’: a qualitative study of the role of paternalism and older people in decision-making when they have lost their capacity. Australasian Psychiatry, 25(6), pp.549-553.
Competing interests: No competing interests
I appreciate the effort to elicit patients' expectations on a large scale.[1] But I wonder whether we should also survey what doctors need from "21st century" patients. I am aware of a 2018 survey on 5956 GPs and GP trainees on ‘What advice would you give your patients about improving their GP appointment?’[2] Some of the advices include trusting the receptionists, booking to see the same doctors, prioritising concerns, and being patient when doctors are late. Nevertheless, the respondents' advice was perceived as "patronizing" and "focused on making life easier for the GPs."[3][4]
I cannot help but notice the double standard when patients and doctors vocalize their expectations. I am aware that my GP colleagues are increasingly upset with patients' expectations to have unnecessary tests and antibiotic prescriptions, and premature referrals to hospital specialists, even before the GPs have done their full assessment. These expectations are difficult to meet and demote doctors’ expertise, but doctors could be reluctant to speak up due to fear of retaliations and complaints.
My understanding is that doctor-patient collaboration is a two-way street. It would only be fair if we can hear the expectations from both sides to determine what changes are feasible. If all that matters is patients' expectations, this proposed survey by Health Education England serves the purpose of only customer satisfaction, which, sadly, may be the direction of medical education nowadays.[5]
References
[1] Rimmer, A. Patients to be asked what they need from doctors. BMJ 2019, 366, l4690, 10.1136/bmj.l4690.
[2] Besser, J. What advice should we give to patients about their consultation? Br. J. Gen. Pract. 2018, 68, 377, 10.3399/bjgp18X698105.
[3] Bennett, C. Editor's choice: What advice should we give to patients about their consultation? Br. J. Gen. Pract. 2018, 68, 467, 10.3399/bjgp18X698981.
[4] Cohen, E. What advice should we give to patients about their consultation. https://bjgp.org/content/68/673/377/tab-e-letters#what-advice-should-we-... (accessed July 31, 2018).
[5] Yeung, E.Y.H. Is the customer always right? BMJ 2018, 361, k2448, 10.1136/bmj.k2448.
Competing interests: I have been paid for working as a physician, but not writing the current letter.
The government wants a survey carried out - asking patients and the public , what they want from 21st century medical graduates.
Do you seriously believe that I , a patient should differentiate between the 21st century graduates and 20th century graduate?
Competing interests: I am a patient. But I am impatient of such senseless surveys
Re: Patients to be asked what they need from doctors
We are debating the future of doctors at an alumni and current students workshop at Guy's Hospital on 26th September.
Much health and continuing care is provided by patients and famlies themselves and maybe the commonly perceived passive status of patients in health creation and health and social care will change with the emergence of communication technologies and a greater emphasis on problem solving alongside traditional medical interventions.
Knowledge, skills and attitudes that in the past were only expected to be found in professionals are now becoming common in citizens, carers and families. The use of shared care records is facilitating this partnership of health between citizen and health care provider. The most significant change that we see with who carry their record is one of ‘knowledge’ and ‘ownership’. This results in a psychological shift in the doctor-patient relationship from one of external control, where the doctor exerts control with a passive patient, to one of internal control where the doctor advises a knowledgeable patient in a two way ‘adult’ relationship.
Full access by patients to records, shared plans, clinical details and natural histories will allow patients to make better responses to crises and changes. Patients will be educated to respond differently to these situations and will use their medical records in a constructive way to prevent the need to contact a service provider for advice.
Patients enter their own clinical data into the records. Diabetic patients will enter their glucose levels. Epileptic patients will the number of their fits, absences or fugues. Hypertensive patients will enter their BP readings. Patients with other conditions enter other data to their records. Patients enter how they feel.
All patients’ carers will have access to the whole record with the patient’s consent. The patient will have the say about the level of access. He will decide who can see the information and will decide which information he does not want to see himself. This information access will be controllable by granular computer technology and will be defined and elucidated by the patient at the beginning of the record and put up for time related review.
Patients may want a second opinion or to move to another provider and will share the record from the old provider with the new specialist to see everything so as not to have tests repeated causing expense and delays.
Competing interests: No competing interests