Full engagement in health
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7476.1197 (Published 18 November 2004) Cite this as: BMJ 2004;329:1197All rapid responses
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Dear Sir
Re Full Engagement in Health (20.Nov.2004)
I have been doing GP Locum sessions in the Tendring Area for the past
two or more years in some seven different practices and have observed the
universal recall of patients for medication review on a very regular
basis. At these reviews the efficacy of the medication is assessed, any
side effects are noted, life style corrections are suggested and
alternative medications, if appropriate, are discussed be they raised by
the patient, their relatives or the Doctor. All these practices are
computerised and therefore notes are easily accessible to the patients on
the screen. Not only that but access is available on the Internet and
current information on the chronic conditions can be downloaded and the
merits of new treatments can be discussed with the patients there and
then. Such appointments also give the patients ample opportunity to
discuss peripheral issues that might be affecting their health.
The move to improve patient involvement and empowerment of their
health care is well underway and I can not believe that only the GPs in
Essex are the only ones leading the way!
Yours faithfully
M J Healy (GP Locum)
Halstead
Competing interests:
None declared
Competing interests: No competing interests
Is the BMJ being taken over by sensationalists, out for a "good
story" at any cost? Already the BBC has put out an antagonstic news
broadcast against UK GPs as a consequence of this report.
My reading of the report is that the survey is based entirely on a
minuscule sample of just over 8,700 patients spread over five countries
and three continents whose combined population must come some hundreds of
millions of patients.
The sample, of less than 1,800 per country, was not apparently
scientifically chosen but randomly picked out, from the top of a number 10
bus, no doubt. We are not told how many UK patients were "sampled". Was
it ten or 8000? Were the national proportions correct?
Bashed and battered as they are by one unfounded adverse report after
another British GPs could well do without the latest Wanless report.
Competing interests:
None declared
Competing interests: No competing interests
Coulter and Rozansky's editorial is a timely reminder that the move
towards patient partnership and shared decision making (the focus of a BMJ
issue in 1997) is stalling. The results of the Commonwealth Fund's study
is not surprising and I would postulate that there are at least two
fundamental causes of the poor British results.
I have just completed a PhD in shared decision making and medical
education and one of the striking findings of my research is that medical
students are rarely encouraged to develop management plans and, if and
when this does happen, they are unlikely ever to discuss these with
patients, let alone involve patients in choosing options. However PRHOs,
particularly those in general practice, are involved in patient management
and develop skills themselves to discuss plans with patients. But
patients are often not given choices; the plans are decided by the
doctors. Those junior doctors who begin to develop strategies to share
decisions are unlikely to be given feedback on their fledging skills.
Undergraduate and postgraduate medical educators need to think about this
area of medical professionalism.
The second cause is related to the GP contracts; in particular the
'new' one of 2004. A colleague of mine, who has been practising as a GP
for many years in Australia, is undertaking a sabbatical in the UK at
present. He reports that GPs are concentrating on meeting the targets of
the new contract with a loss of communication and patient involvement in
consultations. Moreover the move from standard Australian 15 minute
consultations to the UK's 10 affects the doctor's ability and motivation
to discuss options with patients.
Shared decision making does need to begin in primary care, but we
will need to alter the learning and working environments to ensure a good
outcome.
Competing interests:
None declared
Competing interests: No competing interests
Full engagement in health
Dear Sir,
RE.: Full engagement in health
I read with interest the recent editorial by Coulter and Rozansky1
about the above. They refer to the benefits of chronic disease self-
management and the need to build health literacy amongst patients. In
England the Expert Patient Programme2,3 is one route to realising the
former and the Skilled for Health Programme4 the latter.Coulter and
Rozansky also refer to the role of patient empowerment in public health.
However, self-efficacy, which underlies chronic disease self-management,
is also associated with a healthy lifestyle. Thus the principles
underlying the Expert Patient Programme could be extended to the whole
population. Promoting such self-regulation of health–related behaviour
could have enormous benefits in terms of improved health outcomes and
containment of health care costs5. This is also entirely consistent with
the philosophy underlying the new White Paper, “Choosing Health”6, which
aims to support individuals to make informed choices about their health.
Dr Sunjai Gupta OBE
Senior Medical Officer,
Health Improvement Directorate,
Department of Health (and
former Chair of the Expert Patient Programme Implementation Group)
1Coulter A, Rozansky D. Full engagement in health. BMJ 2004;
329:1197-8.
2Donaldson L. Expert patients usher in a new era of opportunity for
the NHS.
BMJ 2003 ;326:1279-80.
3 Gupta S. The Expert Patient Programme and Primary Care: A
Challenge and an Opportunity. Keynote address to the National Chronic
Disease Self-Management Conference, Melbourne 12-14 November, 2003.
Published in Conference Proceedings, 2004.
4 Gupta S. Health literacy and the self-regulation of health-related
behaviour. Presented to the 7th European Health Forum, Gastein, October
2004.
5 Wanless D. Securing our Future Health : Taking a Long-Term View.
Final Report. London, HM Treasury, 2002.
6 HM Government. Choosing Health. Making healthy choices easier.
London, the Stationery Office, 2004.
Competing interests:
former Chair of the Expert Patient Programme Implementation Group
Competing interests: No competing interests