'If we continue to ask patients to give up their time to provide valuable feedback on their doctor's performance, surely we owe it to them at least to ask the right questions?'
The role of the patient in today?s health service is changing all the time. Not only do patients expect more involvement in their treatment and care, but it has become a two-way street as health professionals expect more back in return.
Chief medical officer Professor Sir Liam Donaldson agreed in his report, Good Doctors, Safer Patients,that patients? views on their care should be an essential component of the ongoing regulation of doctors. And the General Medical Council has now conceded to changes that would effectively end self-regulation (news, page 12, 16 November).
This is fine in principle, but the reality is that many of today?s patients are being prevented from contributing to the assessment of their doctors because they are not being given the right tools to do the job. And that is a shame because we know from our research that patients are only too willing to report on their experiences if they think it will make a difference.
So what is going wrong and what tools are needed to complete the feedback cycle?
Patient feedback questionnaires are the most common means of seeking patients? views on individual doctors? performance. Yet when Picker Institute reviewed a selection of those currently being used (which are among the best available), we found that even they sometimes omitted important topics, asked ambiguous questions or were not fully tested out. And there are many others even worse.
So, what needs to be done to avoid time, money and effort potentially being wasted on all sides?
To understand, we have to look at why organisations are not getting it right. Why aren?t they asking patients if their doctor made them feel involved in decisions about their care; if they were given information to support self-care; or if their doctor helped them access support groups or websites? Why are these questionnaires often so different when they are apparently covering the same subjects?
The truth is that with such a wide playing field of areas to cover and the lack of a professional framework to follow, it?s surprising there is any consistency at all. Inevitably, this has led to a rather muddled state of affairs where little tangible evidence can be extracted and used for the benefit of either the health professionals or the patients themselves.
Don?t shoot the messenger
So what can be done? There is no point in adopting a ?shoot the messenger? approach, which is why we believe the solution is to set up a steering group or commission to co-ordinate the process. Its role would be to act as a central reference point, establishing a core of topics and questions that should be included in any patient feedback survey.
Of course, there would be nothing worse than a standard one-size-fits-all questionnaire and we would expect organisations to adapt and add further questions as they saw fit. What it would do, however, is provide the ability to compare and analyse results on these core questions with a degree of competency which doesn?t exist today.
Key subject areas, including the rather controversial topic of whether patients are capable of commenting on the technical competence of doctors, could be debated and key questions agreed. In addition, we believe it would make it easier to develop questionnaires to meet the needs of speciality groups, such as elderly patients or people with one particular kind of condition, instead of using the current format, which is designed for a very broad range of patients.
It is also absolutely essential that questions be reviewed and updated on a regular basis as patient needs and priorities change. This may be a tall order and there will no doubt be those who feel that another steering group is the last thing needed.
The truth is, however, that if we continue to ask patients to give up their time to provide valuable feedback on their doctor?s performance, surely we owe it to them at least to ask the right questions?
Professor Janet Askham is director of research at the Picker InstituteEurope. The institute?s report,Assessing the Quality of Information to Support People in Making Decisions about their Health and Healthcare , was published last week. For a copy, go to www.pickereurope.org