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(2) SHOULD
DRUG COMPANIES BE ALLOWED TO
TALK TO PATIENTS?
(3) ASSERTIVE
PATIENTS ARE "DEEPENING
INEQUALITIES
IN HEALTH CARE"
(4) TREAT
ME AS A PERSON NOT JUST A
NUMBER, SAY
PATIENTS
(5) DON'T
TAKE YOUR HEALTH FOR GRANTED,
SAYS CHRISTOPHER
REEVE
(6) CAN
BEING A PATIENT HELP MAKE A BETTER
DOCTOR?
(7) RESOLVING
THE ETHICAL PITFALLS OF
INTIMATE EXAMINATIONS
(1) PATIENTS REMOVED
FROM GP LISTS FEEL
VICTIMISED
(Patients' accounts of being removed
from their general
practitioner's list: qualitative
study)
http://bmj.com/cgi/content/full/326/7402/1316
Patients who are removed from a general
practitioner's
list feel threatened and see their removal
as an attack on
their right to be an NHS patient, finds
a study in this
week's BMJ.
Researchers interviewed 28 patients who
had been
removed from their general practitioner's
list. The
interviews were often very emotionally
charged, with
patients expressing a range of emotions,
including grief,
anger, hatred, alienation, and depression.
Patients viewed their removal as unjustified
and showed
that they were "good" patients, who attempted
to comply
with the rules they understood to govern
the
doctor-patient relationship.
Patients viewed the removing general practitioner
as
someone who broke the "lay rules" of the
doctor-patient
relationship: that doctors should be caring,
polite,
truthful, and clinically competent and
should value
personal care. According to the patients,
"bad" GPs
broke the "caring" rule by "not being
bothered," not
listening to patients, or not acknowledging
their
concerns.
Patients experienced removal as deeply
distressing and
stigmatising. Some saw their removal as
an abuse of
power by GPs, especially as GPs were not
required to
justify their actions.
This study shows the negative impact of
decisions about
removal on patients, say the authors.
They suggest
measures that could help to mitigate some
of these
effects, such as a clear practice policy
on removal that is
accessible to patients and informing patients
of the
reasons for their removal.
However, the circumstances that lead to
removal are not
straightforward, and the views and priorities
of both
parties—patients and GPs—must be considered
in any
moves to reform this area, they conclude.
Rafat Saeed lives in West London and has
had
difficulties finding a local GP willing
to take him on.
Commenting on the research he says: "Being
removed
without knowing why is very distressing
and most
upsetting. There should not be any discrimination
once a
patient is reallocated, but due to a lack
of communication
and help, discrimination takes place.
Patients have to
carry the burden of being tagged."
Contacts:
Tim Stokes, Senior Lecturer in General
Practice,
Department of General Practice & Primary
Health Care,
University of Leicester, UK
Rafat Saeed, Hounslow, West London, UK
Email: ssrafatrr{at}btinternet.com
(2) SHOULD DRUG
COMPANIES BE ALLOWED TO
TALK TO PATIENTS?
(Should drug companies be allowed
to talk directly to
patients?)
http://bmj.com/cgi/content/full/326/7402/1302
If people are to become more involved in
their own
health care, they must be able to gain
access to high
quality, balanced, accurate, and up to
date information,
but should this information come from
drug companies?
In this week's BMJ, Trevor Jones of the
Association of
the British Pharmaceutical Industry and
Wendy Garlick
of the Consumers' Association go head
to head.
Pharmaceutical companies spend 10-12 years
developing a new drug, which gives them
unparalleled
knowledge and experience of their products.
Yet it
remains the only industry where companies
are forbidden
to communicate with individual customers
about their
products, argues Trevor Jones.
All stakeholders, including the pharmaceutical
industry,
have a part to play in the provision of
information to the
public. It is no longer acceptable to
keep patients in the
dark and to expect them to be happy relinquishing
control of their health care, he adds.
Informed patients can lead to better health
outcomes,
reduction in hospitalisations, and more
patients
complying with their medication. In fact,
the benefits far
outweigh the risks, he concludes.
People are right to be sceptical about
pharmaceutical
companies' ability to be responsible information
providers, argues Wendy Garlick.
A recent survey showed that only 25% of
the public
would trust drug companies to provide
them with
impartial information, and a recent proposal
to lift the
ban on 'direct to consumer advertising'
has just been
rejected by European health ministers.
"The decision shows that the MEPs share
our and
others' views that advertising does not
equate to
education or information."
She believes that there should be one main
portal to
independent and impartial information
on medicines and
treatments, which is stripped of any commercial
or
personal bias. The priority must be to
address what
patients and carers need and want, she
concludes.
Contacts:
Trevor Jones, Director General, ABPI, Association
of
the British Pharmaceutical Industry, London,
UK
Email: abpi{at}abpi.org.uk
Jackie Glatter, Consumers' Association,
London, UK
(3) ASSERTIVE
PATIENTS ARE "DEEPENING
INEQUALITIES IN HEALTH CARE"
(Just how demanding can we get before
we blow it?)
http://bmj.com/cgi/content/full/326/7402/1277
Assertive patients who swallow up doctors'
time with
lists of questions are increasing health
inequalities by
leaving needier patients waiting, according
to an article in
this week's BMJ.
As a child, Hilda Bastian remembers learning
clearly that
part of being "good" at the doctor's was
to say whatever
he or she wanted to hear. But now it worries
her that as
the better equipped patients corner more
and more of
their doctors' time, the people who need
to rely most on
the doctor and find it hard to be assertive
could lose out.
Evidence shows that not being liked by
doctors and
nurses affects your health care. The patient
bringing in
information from the internet has now
joined the ranks of
patients who are commonly disliked.
Obviously, this has to change, writes the
author. But we
need to consider the question of how to
be a "good
patient" in the context of what it will
do to the dynamics
of the doctor-patient encounter.
Doctors talk more to the patients they
identify with and
like. A lack of rapport has been identified
as one of the
major reasons that people from lower socioeconomic
groups or of a different race to their
doctor have worse
health outcomes, she adds.
"By 2013, I hope we know how to cultivate
more
mutual, trusting relationships between
doctors and all
kinds of patients. Just how demanding
can we get before
we blow it for ourselves ? not to mention
take more than
our fair share?"
Contact:
Hilda Bastian, Managing Editor of the Cochrane
Collaboration consumer website, Victoria,
Australia
Email: hilda.bastian{at}cochraneconsumer.com
(4) TREAT ME AS
A PERSON NOT JUST A
NUMBER, SAY PATIENTS
(How important is personal care in
general practice?)
http://bmj.com/cgi/content/full/326/7402/1310
Not being able to see a doctor who knows
you or with
whom you have developed a relationship
could have an
impact on your personal care, finds a
study in this week's
BMJ.
Researchers interviewed patients, doctors,
nurses, and
administrative staff at six general practices
in
Leicestershire to explore their experiences
of personal
care.
Patients described personal care as involving
empathy,
and the perception that health professionals
listened and
"had time" for them. One patient said:
"Dr O helped me a
lot you see. I find it easier to talk
to him cause he listens
really, really well."
Individualised or tailored care was also
an important
theme. GPs and nurses talked about tailoring
their
management of conditions, while receptionists
talked
about tailoring their social talk, as
specific ways of
providing personal care.
Patients often referred to the importance
of professionals
knowing about them and/or their family
history, and a
continuing relationship was central to
many accounts of
personal care. One patient said: "I think
a one to one
relationship obviously makes the care
personal ? and
really that's established over the years."
Practices and individual health professionals
can provide
personal care even when patients do not
consult a
familiar health professional, say the
authors. If GPs and
other practice members wish to provide
personal care, it
is important for them to have good communication
skills,
and the time to use these skills effectively.
Changes in policy and practice in primary
care could
threaten personal care for some patients
if it becomes
more difficult for them to see a health
professional who
knows them or with whom they have an ongoing
relationship, add the authors.
They recommend that practices should have
systems that
enable patients to consult a health professional
with
whom they have an ongoing relationship
whenever they
prefer to do so.
Contact:
Carolyn Tarrant, Research Associate, Department
of
General Practice and Primary Health Care,
University of
Leicester, UK
Email: ccp3{at}le.ac.uk
(5) DON'T TAKE
YOUR HEALTH FOR GRANTED,
SAYS CHRISTOPHER REEVE
(Man and superman)
http://bmj.com/cgi/content/full/326/7402/1287
The actor Christopher Reeve was thrust
into the limelight
after a riding accident in 1995 left him
severely disabled.
In this week's BMJ he talks frankly about
life in a
wheelchair, the importance of taking care
of your health,
and his campaign work for the Christopher
Reeve
Paralysis Foundation.
Reeve decided to use his celebrity status
to campaign for
stem cell research that might help find
a cure for him and
others like him, but he was stunned to
find out just how
controversial it was, particularly in
the United States.
"A number of religions think that destroying
an embryo,
even one that is already destined to be
thrown away as
medical waste is immoral," he says. They
have weighed
in on the issue, talking about the sanctity
of life."
He insists that he is using his celebrity
status responsibly
and believes that his work as a patient
advocate has had
a huge benefit on his mental health. "There
is a reason to
get up every morning, beyond being here
for my family. I
have work to do everyday that may effect
the outcomes
for other patients."
Reeve is also a great believer in being
proactive over
personal health. "I urge people not to
take their health for
granted. To really pay attention to diet
and exercise,
particularly as people get older," he
says.
So what does he think makes a good doctor
and a good
patient? "A good doctor goes the extra
mile for his
patients, in spite of the limitations
of the healthcare
system," says Reeve. "They need to be
independent
thinkers who are full of compassion."
"A good patient should learn everything
he can about his
illness or disability and be willing to
try reasonable
recommendations and meet challenges that
are posed by
doctors or patients. A good patient also
needs to
maintain self discipline."
Contacts:
Maggie Goldberg, Christopher Reeve Paralysis
Foundation, USA
Email: media{at}crpf.org
Lynn Eaton, Journalist and guest editor,
BMJ, London,
UK
Email: leaton{at}bmj.com
(6) CAN BEING
A PATIENT HELP MAKE A BETTER
DOCTOR?
(Doctors' Diagnosis)
http://bmj.com/cgi/content/full/326/7402/1323
What happens when doctors are told they
have chronic
conditions? In this week's BMJ three journalists
meet
three doctors with similar conditions
to discuss the
personal and professional implications
of being both one
of "us" and one of "them."
Mike Shooter, president of the Royal College
of
Psychiatrists, has suffered bouts of depression
throughout his career. He feels his personal
experience
of mental illness has helped his understanding
as a
psychiatrist. "I think it has helped knowing
what it feels
like from inside ? I do think it has given
me a kind of
empathy," he tells Helen Crane, who also
suffers with
severe depression.
Derbyshire general practitioner, Stuart
Bootle, has had
diabetes for 20 years. His experiences
as an NHS
patient have influenced his NHS career,
but the fact that
he is a doctor specialising in diabetes
does not mean he's
a perfect patient. "I don't always look
after myself all the
time — like everyone, I want a balance
in my life," he
admits to Paul Smith, who also has type
1 diabetes.
Former general practitioner, Stephen Hempling,
had
multiple sclerosis diagnosed at 50. Once
his diagnosis
had been made, he found that other general
practitioners
would "shunt" patients with MS to him
on the grounds
that he could empathise. "The thing was
that I liked
seeing them because I liked talking to
them," he explains
to Harriet Gaze, who has MS.
Contacts:
Paul Smith, Reporter, Health Service Journal,
London,
UK
Email: paul.smith{at}emap.com
Harriet Gaze, Freelance Journalist, London,
UK
Email: harrietgaze{at}aol.com
(7) RESOLVING
THE ETHICAL PITFALLS OF
INTIMATE EXAMINATIONS
(Letters: Please don't touch me there)
http://bmj.com/cgi/content/full/326/7402/1326
Intimate examinations are one of patients'
greater
worries. In this week's BMJ, readers respond
to a
survey of medical students published earlier
this year,
which suggested that many examinations
are carried out
without adequate patient consent.
"I was admitted two days before surgery
for a hiatus
hernia," says Mary Selby. "During that
time 12-20
medical students examined me vaginally.
Whilst all asked
permission, and I consented, it never
occurred to me that
I was in a position to refuse. I was upset
by the
examinations and felt both vulnerable
and unclean after
them. Having no advocate on the ward makes
it very
difficult for patients to refuse examinations
which they
would very much like to avoid. I still
wish I had refused."
But how do students acquire clinical skills
without
practising on patients? A new approach
using manikins
with actors has been developed. This ensures
that
students are prepared to deal with contextual
challenges
of real work settings, writes Debra Nestel
of Monash
University, Australia.
Another training programme has been developed
to deal
with these legitimate problems. Students
at Antwerp
University in Belgium perform three procedures,
supervised by intimate examination assistants.
Attention
is focused on personal attitude, the students'
technical
ability and communication skills. Students
reported
feeling more secure while performing intimate
examinations, and paid more attention
to patients'
feelings, integrity, and privacy.
Contacts:
Mary Selby, Principal General Practitioner,
Newmarket,
UK Email: happyselby{at}btinternet.com
Debra Nestel, Lecturer, Centre for Medical
and Health
Sciences Education, Monash University,
Australia
Email: debra.nestel{at}med.monash.edu.au
Kristin Hendrickx, General Practitioner,
University of
Antwerp, Belgium
Email: kristin.hendrickx{at}pandora.be
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