doctor/patient relationships

[Guest guest]

(Good article on the doctor/patient relationship. Topic for

discussion: What is your doctor-patient relationship like?)~ G

BMJ 2003;326:569 ( 15 March )

News roundup

Doctors are servants of patients says chief medical officer

Macdonald London

England’s chief medical officer, Professor Liam son, has called

for a major shake up in the traditional doctor partner relationship.

" We have to see ourselves as the servants of the patient, not their

masters, " he said, introducing a conference last week at the Royal

College of Physicians entitled " The

doctor patient relationship: is it good enough? "

And speaker Ian Kramer, lawyer and vice chairman of the UK Coalition of

People Living with HIV and AIDs, reinforced the theme:

" Patients can and should be viewed not as raw material but as a

resource—as the people who have the answer to your problem, " he said.

Mr Kramer proposed that the doctor-patient relationship should be viewed

as a partnership.

Mr Kramer emphasised the importance of listening to patients’ opinions

on their care. Describing a surgical procedure that he had undergone, he

said his experience had

been much better when doctors paid attention to his requests and

understood that he was an expert on his own body. " The surgeon may have

performed a thousand of these procedures, " he said, " but I doubt if

he’d ever had one. "

He also described the patient’s view of what goes on in hospitals. Mr.

Kramer has to have regular blood tests, and on one occasion a senior

nurse was present to assess the procedure, as well as the usual nurse.

It was only on this occasion that his regular nurse put on latex gloves.

" Only the patient knows this, " he said.

Mr Kramer proposed that patients should be paid for their opinions.

" Advice that is paid for is better advice, " he said. " Chief executives

will take advice more seriously if they have to pay for it. "

Dr Clough, medical director of King’s College Hospital, London,

spoke about the breakdown in communication between doctors and patients.

The most important thing for patients, he said, is " to be seen as

individuals. " But most doctors thought patients just " wanted a cure. "

" Communication skills need to be embedded in medical education, " said Dr

Clough. " They have to be part of every area of teaching and training. "

Dr Clough called for a change in the doctor-patient contract and said

working practices should be changed to prioritise communication and put

the patient at the centre of patient care. He gave one example of a

patient who had said, " The vet told me about my dog in a more humane way

than the surgeon told me about my brain tumour. "

Dr Clough cited rudeness and patronising behaviour as common complaints

from patients. " Some doctors don’t think they have a role in pastoral

care, " he said, " but I think they all do. "