Tapping into that unused resource of patient information - the patients themselves - is too important to the NHS for it to be ignored any longer, says Dr Steven Laitner.
I have made a new diagnosis. It is not on a patient. It is a diagnosis for the NHS and it is this: the NHS suffers from Institutional Paternalism.
It is a chronic condition and very difficult to treat.
But we must treat it. It causes suffering for patients, their carers, health professionals and the tax payer.
Patients and their carers are sick of being patronised, fed up with not having enough information about their condition and its management, frustrated with not being involved and supported in their care.
Health professionals are missing out on the greatest untapped resource in health care – the patient!
Patients help their doctors, nurses and consultants come to the right diagnosis when they listen carefully to their symptoms, ideas and concerns. Patients can help clinicians find the right treatment for them, clinicians can help patients be more involved in their treatment through care planning and self care and help them make the treatment decision that is right for them at that time - through Shared Decision Making. When patients are involved in decisions about their treatment, evidence demonstrates improved outcomes, with more patient satisfaction, more safe and appropriate treatment; reduced complaints and litigation.
Part of the reason that tax payers are not getting the best value from their health care investment is because patients and their carers are not sufficiently involved in decisions. Patients want to be more involved in their treatment and, when they are, the outcome is better and it costs no more.
Shared Decision Making starts with the ethical imperative. At the heart of all good clinical practice is the principle of informed consent. This principle requires that clinicians give their patients information, the power of choice and the opportunity to express their preference. Albeit as the result of benign and well-meaning ‘institutional paternalism’, care regimes which are determined without the patient’s fully informed and empowered consent hover dangerously near the margins of non-ethical practice.
There’s an economic imperative too, one in which value is increased which helps concentrate the mind in the current economic climate.
The policy climate is right to really push home the message about Shared Decision Making, and Andrew Lansley reiterated his commitment to “No Decision About Me, Without Me” yesterday at NHS Confederation. But we are currently far from this being reality so the QIPP Right Care Shared Decision Making Programme is delivering a large programme of work with the challenging aim of embedding shared decision making in routine NHS care.
We are doing this by developing a suite of 36 Patient Decision Aids (web, paper and Apps), together with telephone health coaching support. While simultaneously providing the tools for Shared Decision Making, we are striving to embed the patient decision aids and Shared Decision Making into routine NHS provision and commissioning systems by liaising with the educators of GPs and commissioners and with the providers of GP information systems, among others.
Equally importantly, if not more so, the programme is unrolling a patient pull initiative to encourage patients to demand their right to have a say in decisions about their healthcare, only then will clinical teams really become receptive and translate the undeniable principle into every day reality.
We are at the beginning of a long and challenging journey. But we WILL get there. It is too important not to succeed - for all of us.