Press Releases Saturday 18 September 1999
No 7212 Volume 319
Please remember to credit the BMJ as source when publicising
an
article and to tell your readers that they can read its full text on
the
journal's web site (http://www.bmj.com).
If your story is posted on a website please include a link back to
the source BMJ article (URL's are given under titles).
(1) THIS
WEEK'S BMJ MARKS THE END OF
PATERNALISM
IN THE NHS
(2) INTERNET
WILL CHANGE DOCTOR/PATIENT
RELATIONSHIP
OF THE FUTURE
(3) HOW DO
PATIENTS GET ACCESS TO GOOD
HEALTH INFORMATION?
(4) PATIENTS'
ORGANISATIONS HAVE A KEY ROLE IN
DEVELOPING
THE PATIENT PARTNERSHIP
5) GOVERNMENT
WANTS PATIENT PARTNERSHIP TO
BE INTEGRAL
PART OF NHS
(6) DOCTORS
SHOULD BE REWARDED FOR
PROVIDING
LONGER CONSULTATIONS AND
CONTINUITY
OF CARE
(7) DOCTORS
NEED TO DEVELOP SKILLS TO HELP
THEM INVOLVE
PATIENTS MORE IN DECISIONS
(1) THIS WEEK'S BMJ
MARKS THE END OF
PATERNALISM IN THE NHS
For the first time ever, this week the
BMJ devotes its entire
issue to exploring the changes that have
occurred in the
structure of the doctor / patient relationship
and marks the
end of the paternalistic approach. Angela
Coulter of the
King's Fund, guest editor of this week's
issue, believes that it
is time patients were treated like "grown-ups"
and became
more involved in their healthcare. In
an editorial in this week's
BMJ she writes:
Paternalism is endemic in the NHS (National
Health Service).
Benign and well intentioned it may be,
but it has the effect of
creating and maintaining an unhealthy
dependency which is
out of step with other currents in society.
Assumptions that
doctor (or nurse) knows best"...should
have no place in
modern health care?" The key to successful
doctor-patient
partnerships is therefore to recognise
that patients are experts
too.
The doctor is, or should be, well informed
about diagnostic
techniques, the causes of disease, prognosis,
treatment
options and preventive strategies, but
only the patient knows
about his or her experience of illness,
social circumstances,
habits and behaviour, attitudes to risks
and preferences. Both
types of knowledge are needed to manage
illness
successfully, so both parties should be
prepared to share
information and take decisions jointly.
Commenting on this week's issue, Editor
Dr Richard Smith
says:
We are all very excited about this issue
of the BMJ as we feel
it draws a line in the sand, signalling
that healthcare has once
again moved on. The relationship between
patients and their
doctors is at the very heart of the health
service and it is well
established that patients who are actively
involved in their
healthcare tend to be fare much better.
Moreover they
invariably feel more satisfied with their
treatment and
ultimately, from the point of view of
a financially constrained
healthcare system, they cost the system
less.
By working together with their patients,
doctors can provide
information on the treatment options available;
what the
outcomes are likely to be and explain
the limitations of
medical care ? we all have to face up
to the fact that medicine
can rarely perform miracles. But as Angela
Coulter points out
in her editorial, the tricky bit is for
doctors to determine which
patients want to be offered an active
role in their care and
which would prefer to be more passive.
We hope that this issue will help both
doctors and their
patients to get more out of their healthcare
relationship,
enabling them to make the best healthcare
decisions together
and achieve maximum benefit for the patient.
(Paternalism or partnership? Patients
have grown up and
there's no going back)
http://www.bmj.com/cgi/content/full/319/7212/719
Contact:
Angela Coulter, Executive Director, Policy
and Development,
King's Fund, London
Email: acoulter{at}kehf.org.uk
Dr Richard Smith, Editor, BMJ, Tavistock
Square, London
Email: rsmith{at}bmj.com
or jshepherd{at}bmj.com
(2) INTERNET WILL CHANGE
DOCTOR/PATIENT
RELATIONSHIP OF THE FUTURE
(Promoting partnerships: challenges
for the internet age)
http://www.bmj.com/cgi/content/full/319/7212/761
The internet is transforming healthcare
and is likely to have a
profound effect on the way that patients
and clinicians
interact, claims Alejandro Jadad from
McMaster University in
Canada in this week's BMJ. In light of
this transformation
there are a number of challenges to be
confronted in order to
enable optimal partnerships to develop
between patients and
their doctors writes the author who details
what he perceives
some of these might be.
There needs to be better understanding
of how both patients
and clinicians actually use the internet
and Jadad suggests that
further research is needed in this area.
The internet also has
the potential to greatly alter the traditional
structure of clinical
practice, with consultations conducted
over the web, a
change which will need strong support
from healthcare
planners and policy-makers if it is to
be successful, he says.
He also notes that confidentiality is
bound to be a major
concern about the increased use of the
internet.
The issue of equity in terms of access
to technology and
information is crucial says Jadad. However,
he believes that
new developments in technology are likely
to provide
affordable and fast access to telecommunications
services to
anyone anywhere.
Regardless of how powerful, fast or invisible
technology
becomes, the internet will only be valuable
in promoting
efficient partnerships in health care
if it delivers information
that is relevant, valid, engaging and
ready to apply says the
author.
He concludes that only through innovative
alliances will we
succeed in achieving optimal communication
and access to
high quality, relevant health information
at the right time, in the
right place, and in the right format,
regardless of who we are.
Contact:
Alejandro Jadad, Chief, Health Information
Research Unit,
Department of Clinical Epidemiology and
Biostatics,
McMaster University, Ontario, Canada
Email: jadada{at}fhs.mcmaster.ca
(3) HOW DO PATIENTS
GET ACCESS TO GOOD
HEALTH INFORMATION?
(Helping patients access quality
health information)
http://www.bmj.com/cgi/content/full/319/7212/764
Patients require access to good quality,
evidence based
information so that they are able to take
an active part in
decisions about their health care, write
Dr Sasha Shepperd
from Imperial College of Science, Technology
and Medicine
and colleagues in this week's BMJ.
Even though the amount of information available
to patients is
increasing, particularly through the internet,
the quality of this
information remains variable, say the
authors. Therefore in
order to help health professionals direct
their patients to
sources of good quality consumer health
information they
detail some of the best online sources
(available in the full text
of the paper).
Contact:
Dr Sasha Shepperd, Lecturer, Department
of
Primary Health Care and General Practice,
Division of
Primary Care and Population Health Sciences,
Imperial
College of Science, Technology and Medicine,
London
Email: S.Shepperd{at}ic.ac.uk
(4) PATIENTS' ORGANISATIONS
HAVE A KEY ROLE IN
DEVELOPING THE PATIENT PARTNERSHIP
(Acknowledging the expertise of patients
and their
organisations)
http://www.bmj.com/cgi/content/full/319/7212/771
Partnerships between patients and doctors
can only be
developed if there is investment by government,
if patients'
capacity for managing their own health
is increased and if the
role of patients' organisations is expanded,
writes the director
of a patient group in this week's BMJ.
Judy Wilson of the Long-term Medical Conditions
Alliance
believes that such partnerships should
not be seen as good in
themselves, but as a means to an end for
people living with
long term medical conditions to enjoy
a better quality of life.
Partnerships between patients and clinicians
can also help
make better use of health professionals'
time, writes Wilson.
She concludes that if constraints hindering
the development of
partnerships are tackled, they could make
a real difference to
patients and clinicians.
Contact:
Judy Wilson, Director, The Long-term Medical
Conditions
Alliance, London
Email: alliance{at}lmca.demon.co.uk
(5) GOVERNMENT WANTS
PATIENT PARTNERSHIP TO
BE INTEGRAL PART OF NHS
http://www.bmj.com/cgi/content/full/319/7212/788/b
The current British Government is strongly
committed to the
principles of partnership between the
NHS, its patients, their
carers and the public, writes Gisela Stuart,
Parliamentary
Under Secretary of State for Health in
this week's BMJ.
She draws attention to the launch later
this month of the new
government document "Patient and Public
Involvement in the
New NHS". Ms Stuart explains that this
document will set
out the action which the NHS Executive
is taking to ensure
that patient partnership is central to
its work and what the
government expects the NHS and other bodies
to do to
make working in partnership a reality.
People's expectations of the NHS are changing.
It is now no
longer enough for clinicians to decide
which course of
treatment is best for patients," writes
Ms Stuart. She
continues, "Increasingly, patients want
to know more about
their illness or condition and the different
treatment options
available so that they can make informed
choices about their
own care.
She concludes that the government wants
to see patient
partnership become integral to the work
of every part of the
NHS and that responding to this ambition
is one of the key
challenges facing the health service as
we move into the new
millennium.
Contact:
Gisela Stuart, Parliamentary Under Secretary
of State for
Health, Department of Health, Richmond
House, London c/o
Stephen Mackenney NHS Executive, Leeds
Email: Stephen.Mackenney{at}doh.gsi.gov.uk
(6) DOCTORS SHOULD BE
REWARDED FOR
PROVIDING LONGER CONSULTATIONS AND
CONTINUITY OF CARE
(Quality at general practice consultations:
cross sectional
survey)
http://www.bmj.com/cgi/content/full/319/7212/738
It may be time to reward general practitioners
who have
longer consultation times, provide greater
continuity of care
and enhance patients' understanding of
illness and their ability
to cope ("enablement"), claim a team of
researchers in this
week's BMJ.
Professor John Howie and colleagues from
the University of
Edinburgh and Imperial College School
of Medicine in
London, studied nearly 26,000 (25,994)
adult patients
attending 53 practices in Lothian, Coventry,
Oxfordshire and
west London. They found that the mean
duration of
consultation for all patients was eight
minutes and that those
patients who spent the longest periods
with their doctor were
more likely to feel enabled. This was
also true of those
patients who know their doctor well.
However, Howie et al also found that the
doctor's ability to
enable their patients was inversely related
to the size of their
practice, and this, say the authors, should
be heeded by those
advocating bigger organisations as the
way to improve
general practice services. They advance
the suggestion that an
incentive should be introduced into general
practitioner
contracts to reward doctors who spend
more time at
consultations, provide greater continuity
of care and both
enable more patients and enable patients
more.
Contact:
David Heaney or Margaret Maxwell, Research
Fellow,
Department of Community Health Sciences-General
Practice,
University of Edinburgh, Edinburgh
(7) DOCTORS NEED TO
DEVELOP SKILLS TO HELP
THEM INVOLVE PATIENTS MORE IN DECISIONS
(Towards a feasible model for shared
decision making: focus
group study with general practice
registrars)
http://www.bmj.com/cgi/content/full/319/7212/753
Sharing decisions with patients entails
doctors sharing the
uncertainties that exist about the outcomes
of medical
treatments and often revealing the fact
that no one knows
what the outcome is likely to be, say
researchers in this
week's BMJ. This can cause anxiety to
both the patient and
the clinician and therefore the training
of general practitioners
should include the development of skills
to tackle these
difficulties say the authors.
Dr Glyn Elwyn from the University of Wales
College of
Medicine and colleagues from Wales and
the Netherlands
report on their study of 39 general practice
registrars. They
found that attitudes towards involving
patients in decisions
about their treatment ranged from being
highly positive to
being more circumspect. The authors therefore
conclude that
moves towards enhancing patient involvement
in decision
making will depend on developing both
skills and attitudes of
professionals.
Contact:
Dr Glyn Elwyn, Senior Lecturer, Department
of Postgraduate
Education for General Practice and Department
of General
Practice, University of Wales College
of Medicine, Cardiff
Email: elwynG{at}cf.ac.uk
Or
Mary Leyshon, Press Office, University
of Wales College of
Medicine, Cardiff
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact Jill Shepherd;pressoffice{at}bma.org.uk)
and from:
the EurekAlert website, run by the American Association for the
Advancement of Science
(http://www.eurekalert.org)
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