In addition to working as a professional in patient and public involvement, I have recently had first hand experience of being a patient under complicated and worrying circumstances that will have serious consequences for the way I live and the future choices I have to make. This has taken me back to MAC basics about how the users of services can and should influence the quality and delivery of the services that are provided.
Lip service to patient consultation
My professional experience tells me that we are in a time when much is said about public consultation and public involvement in the design and delivery of public services. However my personal experience questions whether this is genuinely meant. I find that lip service is being paid to consultations and engagement exercises across many of our vital public services and none more so than health – and this has to change.
Patients have never had it so good
Patients have been led to believe that their opinions and preferences and even criticisms were wanted by the health service and that this would be used to improve services and make them more user-friendly. However the reality is that many hospitals and most GP’s find it difficult and time consuming to consult their patients and if they are being honest, they cannot really see the point. They believe patients are getting a better health service now than ever before and that the providers of these services understand the complexity of treatments and requirements for the efficient delivery of health services far better than patients ever will – and some of this is true!
Doctor knows best
However many hospital doctors and GP’s also believe that they know what’s best for their patients not just in terms of diagnosis and treatment but also in terms of access to medical facilities, time off work, family life style, dieting and exercise and even personal relationships. In the space of a five or ten minute consultation, a hospital consultant or a GP will make very serious, life altering decisions about the health of the patient before them and the appropriate treatment. They will also make huge assumptions about the personal circumstances of that patient and specify life style requirements and changes which may be well outside the patients sphere of control or indeed outside their personal experience and preferences. The fact is that most doctors and nurses consider patients have no need or right to comment on the way in which services are delivered in their clinic or surgery and you have a big gap between the official claims and aspirations about public involvement and the reality on the ground.
Things have got better but…
Most patients who have attended their GP surgery in the past few years, will have seen significant improvements in the frequency and variety of opening times. Many patients have seen a choice of GP being offered and telephone consultations being welcomed. Some patients know from personal experience that their surgeries have made it easy to obtain repeat prescriptions and to collect medication direct from the local chemist. But I know from speaking to many patients that there are still plenty of surgeries where the Receptionists are unhelpful and even antagonistic towards patients and guard the doctors as if seeing their patients was not a vital part of being a General Practitioner.
Still just a number
Many hospital patients that I have spoken to tell how they were treated as a number without being acknowledged as individuals who are unwell and often under some stress from their medical circumstances. Some patients even tell of hospital visits where they were asked to take off their clothes and then left alone in a cubicle for half an hour or, perhaps worse, surprised when their consultant arrived with a team of medical students to observe them in their embarrassed nudity. However I am pleased to say that I also know of consultants and registrars who read the patients notes before they call them into the consulting room and then have good eye contact with the patient, make sure they get the name right and put the patient at ease. Perhaps these are the doctors who listened to feedback from patients about how they are treated.
The way to good doctor- patient relations
Treating a patient as an individual with intelligent thoughts and reasonable feelings is the first step to a good patient-doctor relationship and this can begin in the waiting room or even on the phone when you make an appointment. It can be reflected in the availability of toilets and the layout of the waiting room and it can be reinforced by the explanatory, back up information given to patients about their condition and their treatment.
Good use of technology
In this day and age of computer technology, seeking patients’ views through electronic surveys and questionnaires is not very difficult or expensive. Even the most traditional GP practice has access to computers and can get advice on how to use and adapt existing surveys and other patient involvement tools without a big financial outlay.
Choice without changing your doctor
A lot has been said over the past few years about patient choice and treating the patient as a customer. However, one of the things most patients wish to avoid is changing their doctor – it is not like changing supermarkets! Changing GP causes interruption in treatment and disruption in relationships and leads to wrong assumptions and confusing questions about who did what to make a change necessary. Most patients want to stay with their existing doctor but want him or her to be open and forthcoming about the medical situation facing them both. Most patients want diagnosis and treatment to be explained with a chance to ask questions. Most patients want to know if there is scope for them to have a preference about their treatment or if there are any choices they can make whilst still following their doctors best advice.
The positive way forward
All this can be achieved without costing a lot of money and without taking hours of extra doctors’ time with every patient. Patients can be encouraged to phone with queries and be helped by the duty doctor or nurse if they don’t actually need a face to face appointment with the GP. Before or after appointments, reception staff can seek patients’ views and opinions or they can hand out comment forms and questionnaires. Patients can be invited to participate in patient “get-togethers” or meetings about specific issues or to participate in an on-going Patient Group. Those patients who have email facilities can be sent questionnaires or surveys and they can be invited to join a “virtual patient group”. GPs can also have a good working relationship with their local pharmacy to ensure they can explain the use and side effects of medication to patients and they can even notice when a clash of drugs may be indicated. These are just a few of the many ways in which patients can be more involved in contributing to the way their health services are delivered.
And there is help available
The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations. We are ready to work with and support all those who want to make sense and a success of the new structures of patient and public engagement within the new arrangements for health and social care commissioning and providing. Feel free to contact us to discuss the opportunities.