Are Colquhoun's observations about patient-centred care in his piece
on the fruitcake wellbeing business a not-so-elaborate exercise in leg-
pulling?1 Who wouldn't prefer curing over caring? - but we know this isn't
always an option, and it is in this context that the patient-centred
approach is particularly salient.2 The idea behind engaging with patient
experiences of living with illness and sharing decisions about treatment
isn't that patients know more about medicine than the clinician, but that
they have insight into their own lives and values, and how these might, or
might not, fit with 'medically reasonable' treatment options
available.3;4;5 Though the approach tries to engage with the fact that
people make choices about their health in the wider context of their lives
- where the 'medically reasonable' option may seem entirely unreasonable6
- this far from negates the clinician's role as expert informant and
adviser. Provision of meaningful information has been a central thrust of
the shared decision-making project, with some promising results in helping
people make big choices about their health5 - and this is no less relevant
in supporting the minutiae of decisions patients make day-to-day when
living with a regimen.4
What Colquhoun might have pointed out is that
even when there are a range of options for care (which of course there
isn't always), or scope for flexibility in the regimen, engaging with
people's experiences and involving them in decision-making can't make the
daily challenges of living with illness disappear - and much as people may
wish for their doctor's understanding and sympathy, erosion of the moral
certainties of a more authorative consulting style may be unsettling for
some patients and clinicians alike.7 So, maybe that's why Colquhoun's
gifted diagnostician is so grumpy (shades of Gregory House anyone?) -
though surely nothing a spot of angel therapy couldn't sort out?
1. Colquhoun D. The A to Z of the wellbeing industry: from angelic
reiki to patient-centred care. BMJ 2011; 342:d2711
2. Robinson I. Multiple Sclerosis. 1988. London, Routledge
3. Coulter A. Implementing shared decision-making in the UK. 2009. London:
The Health Foundation
4. Curtis-Tyler, K. Levers and barriers to patient-centred care with
children: findings from a synthesis of studies of children's experiences
of living with type 1 diabetes or asthma. Child: care, health and
development. 2010. DOI: 10.1111/j.1365-2214.2010.01180.x
5. O'Connor AM., Bennett CL, Stacey D, Barry M, Col NF, Eden KB, Entwistle
VA, Fiset V, Holmes-Rovner M, Khangura S, Llewellyn-Thomas H, Rovner D.
Decision aids for people facing health treatment or screening decisions.
Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD001431.
DOI: 10.1002/14651858.CD001431.pub2
6. Graham H. Women's smoking and family health. Social Science and
Medicine. 1987; 25: 47-56
7. Bissell P, May CR, Noyce PR. From compliance to concordance: barriers
to accomplishing a reframed model of health care interactions. Social
Science and Medicine. 2004. 58: 851-62
Rapid Response:
Re:The A-Z of the well-being industry
Are Colquhoun's observations about patient-centred care in his piece
on the fruitcake wellbeing business a not-so-elaborate exercise in leg-
pulling?1 Who wouldn't prefer curing over caring? - but we know this isn't
always an option, and it is in this context that the patient-centred
approach is particularly salient.2 The idea behind engaging with patient
experiences of living with illness and sharing decisions about treatment
isn't that patients know more about medicine than the clinician, but that
they have insight into their own lives and values, and how these might, or
might not, fit with 'medically reasonable' treatment options
available.3;4;5 Though the approach tries to engage with the fact that
people make choices about their health in the wider context of their lives
- where the 'medically reasonable' option may seem entirely unreasonable6
- this far from negates the clinician's role as expert informant and
adviser. Provision of meaningful information has been a central thrust of
the shared decision-making project, with some promising results in helping
people make big choices about their health5 - and this is no less relevant
in supporting the minutiae of decisions patients make day-to-day when
living with a regimen.4
What Colquhoun might have pointed out is that
even when there are a range of options for care (which of course there
isn't always), or scope for flexibility in the regimen, engaging with
people's experiences and involving them in decision-making can't make the
daily challenges of living with illness disappear - and much as people may
wish for their doctor's understanding and sympathy, erosion of the moral
certainties of a more authorative consulting style may be unsettling for
some patients and clinicians alike.7 So, maybe that's why Colquhoun's
gifted diagnostician is so grumpy (shades of Gregory House anyone?) -
though surely nothing a spot of angel therapy couldn't sort out?
1. Colquhoun D. The A to Z of the wellbeing industry: from angelic
reiki to patient-centred care. BMJ 2011; 342:d2711
2. Robinson I. Multiple Sclerosis. 1988. London, Routledge
3. Coulter A. Implementing shared decision-making in the UK. 2009. London:
The Health Foundation
4. Curtis-Tyler, K. Levers and barriers to patient-centred care with
children: findings from a synthesis of studies of children's experiences
of living with type 1 diabetes or asthma. Child: care, health and
development. 2010. DOI: 10.1111/j.1365-2214.2010.01180.x
5. O'Connor AM., Bennett CL, Stacey D, Barry M, Col NF, Eden KB, Entwistle
VA, Fiset V, Holmes-Rovner M, Khangura S, Llewellyn-Thomas H, Rovner D.
Decision aids for people facing health treatment or screening decisions.
Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD001431.
DOI: 10.1002/14651858.CD001431.pub2
6. Graham H. Women's smoking and family health. Social Science and
Medicine. 1987; 25: 47-56
7. Bissell P, May CR, Noyce PR. From compliance to concordance: barriers
to accomplishing a reframed model of health care interactions. Social
Science and Medicine. 2004. 58: 851-62
Competing interests: No competing interests