The Doctor/Patient Divide: As Far Apart As Ever?
Yesterday I re-blogged Alexandra Fulford’s post commenting on an article which appeared in USA Today. According to Niam Yaraghi patients are incapable of managing or understanding their own health and should leave it all entirely up the medical professionals.
“Patients are neither qualified nor capable of evaluating the quality of the medical services that they receive. How can a patient, with no medical expertise, know that the treatment option that he received was the best available one?”
This morning I woke to another robust discussion, this one prompted by a new promotional video launched by The Royal Australian College of General Practitioners which charts the changing role of a general practitioner in providing health care to patients.
What’s interesting is how reactions to this video, which has been met with acclaim by doctors, have highlighted once again a continued lack of recognition and respect for the changing role of patients in the doctor/patient clinical consultation.
Here is how Michelle Roger, who lives with dysautonomia, views the video:
It was one sided and the patients appeared little more than props to be talked at. In fact the patients had no voice at all. A problem that still permeates a lot of medicine.
Jen Morris, who like Michelle, is a passionate and outspoken patient advocate, observes:
From a patient perspective, the most glaring thing about the ad is that across 90 seconds, encompassing 10 consultations, the GP dominates 100 per cent of the dialogue. No patient or their family member says a word. Not one word. The two minute version is no better. As a result, the campaign represents the idealised ‘good GP’ as one who delivers news – and commands – to artificially muted patients. No conversation. No questions (from patient or doctor).
Every day in the course of my work, I come across patients, doctors, nurses, and allied health professionals, who work tirelessly to transform the traditional doctor/patient paradigm – one in which doctors hold all the answers, and patients must comply with their medical expertise. A few months ago, David Gilbert, yet another passionate and outspoken patient advocate (yes, there are many!) took an analytical, evidence-based approach, using his research as a CLAHRC NW London fellow, to outline seven key benefits patients bring as partners in healthcare. It’s deeply depressing therefore this week to have the face the reality that for all the patient-centred care rhetoric that abounds, we are still a long way from recognizing that health expertise lies outside as much as inside medical circles. We can’t just talk about a commitment to patient centred care– we have to live it. It is only by bridging the divide which places patient and doctor expertise on opposite sides that we can achieve more personalized and meaningful care of the patient.
The question now is how do we start to bridge that divide in tangible and meaningful ways?
Hi Marie and thanks so much for this! Wanted to point out that Niam Yaraghi is NOT a physician (he got a PhD in 2014 and now works at a think tank, not (THANK GOD!) with real flesh and blood patients – a fact that apparently doesn’t stop him from making preposterous claims like:
“While the interaction between patients and their medical providers is an important element of the medical care process, it is not the most important one.”
His editorial has been met with understandable sputtering on social media (although Casey Quinlan – @mightycasey – actually phoned him up yesterday about his post – so stay tuned!)
Kindest regards always,
Carolyn, thanks for the clarification, which I’ve seen to in the post. Appreciate your comment.
Without a partnership with your medical team, there are no winners.. not ever.. As a cape wearing turtle this is so very clear to me and really important.. I do not see myself as an idiot that should be ignored (unless I have been missing something!!!). It is my life, my body and my squatters (Advanced Breast Cancer) and quality of life is as important as treatment which is as important as the teamwork with my medicos that makes it all come together..
Casey’s update following her 30 minute phonecall with Niam: “Patients ARE Smarter (And Louder) – http://mightycasey.com/patients-smarter-louder/ Also, see her note about the Google Hangout event, June 24th 3pm EST – https://plus.google.com/u/0/events/co95pcvfi9jc2ltv2cacdpgqjvo
In recent times I have felt very disillusioned with the medical profession… If you have no answers to fix me then at least find out what I need in the way of practical help… Not just passing me on to more doctors for more of the same… We are people we have feelings… Talk to us!!!
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You have brought up such an important subject. I am trying to deal with the same issues for chronically ill children. I have a blog: http://iamnotsickboy.com and I recently founded a nonprofit, Making Change For Children, where I am working daily to share my ideas to hospitals, charities, and other medical personnel who have the power to change things. We all have to unite to fix our broken healthcare system.
One way is that we need service organisations to encourage people to tell their story about what went well, and what could be improved as a result of their visit. But they need to feel safe in telling their story. Patient Opinion (www.patientopinion.org.au) is a public place (independent, annonymous and constructive) where these stories can be told.
I brought Niam Yaraghi and Casey Quinlan together for a Google Hangout on Air to try to advance the conversation into productive territory. Check it out, and you be the judge of whether we succeeded. In any event, please take a look at the accompanying post, and please weigh in on the questions I pose at the end about how to make patient reviews of physicians more useful. See: On Making Patient Reviews of Physicians More Useful | e-Patients.net – http://shrd.by/ydoP5Y
Thanks so much for organizing that Google Hangout event, David – and thanks for moderating it in such a professional and fair-minded fashion. I urge readers here to watch the video – http://shrd.by/ydoP5Y
In your post, you correctly identified two types of patients “qualified to review doctor(s) not just in terms of bedside manner, but in terms of clinical quality of care” These two types are:
1. The patient with a chronic condition who is more knowledgeable about her condition and the latest research regarding therapies and other approaches to managing the condition than is her new doctor. ( * I’d delete that word “new” however as this is also inherently true for longtime care providers).
2. The patient whose condition had been misdiagnosed (and therefore effectively left untreated) by three doctors. Doctor #4 correctly diagnoses and treats the condition.
You’d think that even Niam would acknowledge that this category of patients might qualify to meet his exacting standards of who’s good enough to evaluate health care quality (beyond just “decor”, of course, which we are apparently eminently qualified to critique!) – but NO. Later in your video, he specifically balks at this, insisting that these two types are in fact “rare”.
They may be “rare” in his world, but certainly not among my real life readers and audiences.
But even among patients who don’t fit neatly into those two categories, Niam then concedes, oddly, that “a patient has eyes” capable of assessing patient safety measures, for example, by noticing hand hygiene infractions when a doctor fails to wash hands before touching them. You don’t need to be in #1 or #2, or have a PhD, to figure out that there’s some disconnect here between patients with eyes and Niam’s assertion that “patients are neither qualified nor capable of evaluating the quality of the medical services that they receive.” So which is it?
Are we doomed, as Casey wisely points out, to continue comparing “apples to chain saws” unless academics/IT people/”experts”/non-patients try to stop making assumptions about a population voice they’ve clearly not yet met? Patients know stuff, as Casey reminds us. What we also know is that it’s foolish to make sweeping generalizations about patients and our ability to assess the quality of care we receive.
Carolyn, thank you so much for commenting here – I missed the conversation and am looking forward to catching up with the discussion as soon as I can. Ironically I missed it as I am travelling for some presentations this week – sharing my patient expertise! David thank you for facilitating the discussion. I am really interested to hear and see how it played out. Marie