Historically clinicians made clinical decisions on behalf of patients, so called paternalistic practice. In the last 20 to 30 years, this approach has received much criticism.1,2
In the last decade, patient-centred care, respect for personal autonomy and informed consent have become the bedrock of how healthcare is delivered.3 Patient- centred care is defined by the Institute of Medicine as, "providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions."3
Achieving patient-centred care can be difficult but is important, and policy support for patient-centred care may improve the efficiency of care delivered.4-5 There are a huge number of approaches used to achieve patient-centred care,4-5 two of which will be touched upon here.
One simple approach is to post copies of patients’ letters between healthcare professionals to the patient, recommended by the then Labour government in 2004. In an outpatient clinic, patients may forget aspects of the consultation and a letter reinforcing the major action points is of benefit and may even improve adherence to medications.6 Patients may use information in clinic letters actively to help manage their own condition and may use it to form the basis of future discussions with doctors.6
This approach has been shown to be beneficial, with a study of 500 patients noting that 95% of patients were in favour of the practice and 93.4% understood all or most of the contents of the letter.7 The authors suggested that copying patients into their GP letters is both a useful and popular practice for patients and had little impact on the running of the department.7 Another study noted that although copying the letter to the patient increased further contacts for clarification, this additional communication was often beneficial for patient care.8 There are some limitations to this approach in areas with low literacy rates, for example and there remain some issues regarding confidentiality. The British Geriatrics Society sees considerable merit in the policy, noting that this practice may lead to greater openness and transparency in the clinical care of older people and help address ageist attitudes by promoting patient inclusion in their care.9
A second way of improving patient-centred care is through embracing technology. One such example of this is Renal Patient View (RPV),10 a project aiming to provide online information about renal patients’ diagnosis, treatment, and their latest biochemical results. On RPV patients can view graphs showing their renal function/blood tests, access evidenced-based information about their specific diagnosis and can communicate with their clinical team regardless of their location. RPV fundamentally enables clinicians, GPs and patients to work together as a team to help patients manage their renal disease.
There are other programmes in European countries whereby patients have access to view their own clinical imaging and report alongside their GP. More widely telehealthcare provision, fast becoming an important means of managing long-term conditions and patients in rural localities, also holds promise in terms of providing patients with a cost-effective and clinically effective choice about how their healthcare is provided.11
In the coming years the use of technology will undoubtedly provide opportunities to improve the provision of patient-centred care. However, the simple approaches such as providing patients with a paper copy of their own clinical letters cannot be over-estimated. Simple sometimes is best.
With thanks to John Cordina Consultant Geriatrician, Karin Grech Hospital, Malta
1) Savulescu J (1995). Rational non-interventional paternalism: why doctors ought to make judgments of what is best for their patients. Journal of Medical Ethics. 21: 327-331
2) Hall H (2008). Paternalism Revisited. Science Based Medicine Online. Available from: http://www.sciencebasedmedicine.org/paternalism-revisited/ [Last accessed July 23rd 2013]
3) Crossing the Quality Chasm: A New Health System for the 21st Century (2001). Report by the Institute of Medicine. Available from: http://iom.edu/Reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx [Last accessed July 23rd 2013]
4) Epstein RM & Street Jr RL (2011). The Values and Value of Patient-Centered Care. Ann Fam Med. 9(2): 100-103
5) Sepucha KR, Fowler FJ Jr & Mulley AG Jr (2004). Policy support for patient-centered care: the need for measurable improvements in decision quality. Health Aff (Millwood). Suppl Variation:VAR54-62
6) Harris C, Boaden R (2006). Copying letters to patients: the view of patients and health professionals. J Health Serv Res Policy. 2006 Jul;11(3):133-40.
7) Pothier DD, Nakivell P, and Hall CEJ (2007) What do Patients Think about being Copied into their GP Letters? Ann R Coll Surg Engl. 89(7): 718–721
8) Earnshaw J, Costello A & Godsell S (2006). Copying outpatient clinic correspondence: letter to patient or GP? Health Service Journal Online Available from: http://www.hsj.co.uk/resource-centre/copying-outpatient-clinic-correspondence-letter-to-patient-or-gp/3196.article [Last accessed July 23rd 2013]
9) British Geriatrics Society Guidelines. Guidelines for geriatricians on copying letters to patients (2008). Available from: http://www.bgs.org.uk/index.php/topresources/publicationfind/goodpractice/42-gpgpatientletters
(Last accessed Aug 4th)
10) Renal Patient View Online. Available from: https://www.renalpatientview.org/ [Last accessed July 23rd 2013]
11) McKinstry B (2012). Telehealth‐ A Developing Field. Scottish Universities Medical Journal. 1(2):180‐ 183