IN NEED OF TLC

By Frauke Sinclair
Contact the author by e-mail at frauke@scottishcouncilfoundation.org

A new paper by Frauke Sinclair finds all is not well with the doctor-patient relationship.

Trust is crucial for the relationship between patients and doctors to work. Without trust, we would not seek doctors' advice. We are living in a society which is increasingly less hierarchical, and where less deference is exhibited towards experts than in the past. At the same time, the public access more medical information both through the internet and media reports on health issues. We have increasingly high expectations of health providers, and expect choice of treatments and a say in decision-making - this is reflected in the patient-focused, patient choice health agenda.

There has been much talk about a decline in trust, and growing public distrust of professionals and institutions. This is not immediately evident when it comes to trust in doctors. In opinion polls, doctors score high on trust and consistently come top as the most trusted professionals.

But all is not well in the relationship between doctors and patients. Further examination of the evidence shows that:

trust in doctors is often qualified, rather than unconditional
large proportions of patients do not follow their doctors' advice, do not take prescribed medicines and hide their concerns from their doctors
doctors' views about patients' roles in decision-making are sometimes at odds with the patient-focused, patient choice health agenda
many patients want more involvement in decisions about their care and treatment than they currently experience
at the same time, a substantial minority of patients do not currently wish to have an active role

Patients bring their own views about their illness and about medicine in general into the consultation. Results of recent research shows that these views shape how they respond to their doctor's advice yet are rarely discussed during the interaction with doctors.

Studies show that patients who feel they have been given enough information about their treatment are more confident in their doctors. Too many patients are currently dissatisfied with how doctors communicate with them and the amount of information they receive from them. What patients want is for doctors to listen to them carefully, and for doctors to possess the ability to express themselves in a way they can easily be understood.

We also need to learn to communicate better with doctors, be open about our concerns, express ourselves clearly and assertively. We should also be prepared to have our views challenged by doctors.

It is vital that patient choice is about informed choice - only an informed public can make meaningful decisions about their treatment and care options. We should expect doctors to be able to explain why a requested treatment is inadvisable or unavailable. Studies have shown that patients want medical advice from a range of sources, and that while doctors and other health professionals are valued sources, printed material and information accessed through the internet are important too. We need to increase access to a range of different sources for health information, and ensure information is of good quality, is provided at different levels of detail and can be understood by different groups.

Improved communication needs to be accompanied by increased efforts to engage patients. The overall policy framework acknowledges patients' roles in decision-making, and patients with chronic conditions are recognised as experts of their condition - this should be extended to all patients. The case for involving patients must be reinforced by policy-makers and researchers who need to communicate the benefits of patient involvement more effectively to practitioners. Only recently have convincing steps been taken to adapt medical education and training. Doctors should play a greater role in trying to engage more passive patients, for example, by asking questions aimed at understanding patients' views and by explaining options in a way they know patients can understand.

Joint decision-making is about creating more satisfied and more responsible patients who play an active role in their health and wellbeing. Patient-focussed consultations may be more time-consuming but can save time in the long run through fewer return visits. If we are serious about patient engagement, there is no alternative.

To push the new health agenda forward, we also need a public discussion about some of the tensions inherent in patient decision-making on the one hand, and doctors' professional responsibility on the other. Such a debate should involve the public in a meaningful manner.

The health agenda has been patient-focussed for some time, but medical education is only starting to catch up. Now is the time to make the case for the patient-focused agenda more effectively and more forcefully, and ensure doctors are listening. This way the frictions apparent in the doctor-patient relationship can be tackled, to ensure the relationship will be fit for the future.

Frauke Sinclair

A full version of this paper is available at: http://www.scottishcouncilfoundation.org/page.php?id=16.

Frauke Sinclair is Leader of SCF's new Knowledge Exchange theme. She can be contacted at: frauke@scottishcouncilfoundation.org

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.