Published: 05/12/2002, Volume112 No. 5834 Page 35

Ending paternalism in medical care By Angela Coulter Publisher: The Nuffield Trust. ISBN 0117030562. 120 pages.£5.99. Available from the Nuffield Trust (020-7631 8450) and www. tso. co. uk Professor Angela Coulter, chief executive of Picker Institute Europe, delivered the Nuffield Trust's John Fry lecture this autumn.

In it, she predicted that demands for more accountable healthcare systems and higher quality would continue into the next decade, driven by medical scandals and international comparisons.

She also predicted increased demand for 'lifestyle' drugs and the medicalisation of normal life processes such as childbirth, driven by professional and commercial interests.

In response, Professor Coulter argued that clinicians and policy makers must recognise the patient's right to choose.

'Far from being peripheral, the development of a more active role for the patient and citizen will be fundamental to securing the future of public healthcare. It is the only way to ensure its affordability, acceptability and sustainability over the longer term.'

This book expands on the lecture, setting out new roles for the patient as decision maker, care manager, evaluator and 'active citizen'.

A final chapter looks in detail at the impact on primary care and argues that it may need to be substantially reorganised to meet new demands.