http://bmj.com/cgi/content/full/323/7318/0

 

BMJ 2001;323 ( 20 October )

Editor's choice

Doctors and patients: flying apart?

"Patient centred care" sounds like irritating jargon to many doctors. Hasn't their care always been patient centred? A group from Southampton has analysed almost a thousand meetings between doctors and patients to find out what patient centredness is and whether it matters (p 908). Their conclusion is that if doctors don't provide a positive, patient centred approach, then patients are less satisfied, feel worse, and are more likely to be referred to other doctors.

What then is patient centredness? The first component is that the doctor is sympathetic, interested in the patient's worries and expectations, and discusses and agrees the problem and treatment. Next, the doctor knows the patient and his or her emotional needs and is definite about the problem and when it will settle. The doctor also practices health promotion and takes an interest in the patient's life. This sounds somewhat like "good old fashioned general practice," but a fifth of the patients thought that doctors weren't much interested, less than half agreed that doctors understood their emotional needs, and half didn't think that the doctor knew them well.

Time may be part of the problem. No fewer than 96% of over 23 000 general practitioners in Britain surveyed by the BMA think that "too much is being asked of general practice at the present time" (p 887). Half want to reduce their hours of work, and two thirds describe their morale as fairly or very low. Almost half would like to retire before 60 and another third at 60. Meanwhile, a survey of consultant physicians by the Royal College of Physicians finds that they are working an average of 21 hours a week more than they are contracted to (p 888).

There may not be time for patient centredness, which may explain part of the strain being felt by both the NHS in Britain and the Canadian health service (p 926). A quarter of the general practitioners surveyed in Britain think that patients should pay a fee to consult them and almost half agree with the statement that "The NHS can no longer remain a comprehensive service, even with significant extra resources."

Anthony Browne, health editor of the left leaning Observer newspaper, shocked readers two weeks ago by announcing that he had lost faith in the NHS and thought that Britain needed to find new ways to deliver health care, by using insurance and charging fees (p 941). Browne expected a barrage of hostility, but the negative criticism was overwhelmed by messages of support.

Against this somewhat gloomy background, we are pleased to announce an innovation in the BMJa new occasional article from our science editor that explains how things work. This week she covers oscillatory blood pressure devices (p 919).

Footnotes

To receive Editor's choice by email each week subscribe via our website: www.bmj.com/cgi/customalert

© BMJ 2001

PDF of this article Email this article to a friend Send a response to this article Other related articles in BMJ Download to Citation Manager Alert me when: New articles cite this article

Other related articles in BMJ:

NEWS
Quarter of GPs want to quit, BMA survey shows.

Zosia Kmietowicz
BMJ 2001 323: 887. [Full text]  

NEWS ROUNDUP
UK physicians work 21 hours a week more than contracted, says report.

Susan Mayor
BMJ 2001 323: 888. [Abridged text] [Full text]  

PRIMARY CARE
Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations.

Paul Little, Hazel Everitt, Ian Williamson, Greg Warner, Michael Moore, Clare Gould, Kate Ferrier, and Sheila Payne
BMJ 2001 323: 908-911. [Abstract] [Full text]  

CLINICAL REVIEW
How does it work?: Oscillatory Blood Pressure Monitoring Devices.

Abi Berger
BMJ 2001 323: 919. [Full text]  

EDUCATION AND DEBATE
The future of health care in Canada.

Steven Lewis, Cam Donaldson, Craig Mitton, and Gillian Currie
BMJ 2001 323: 926-929. [Full text]  

PRESS
Press: Are the media losing faith in the NHS?.

Alex Vass
BMJ 2001 323: 941. [Full text]  

ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.