How to make the medical consultation more successful from a patient's perspective? Tips for doctors and patients from lay people in the United Kingdom, Italy, Belgium and the Netherlands
Introduction
Most doctors, health care managers and policy makers will say that the patients’ position is central to health care; unfortunately, despite this advocacy, patients seem to be easily overlooked. Debates on the quality of care [1], the cost-effectiveness of certain interventions [2], or interventions for practice improvement [3] largely pass over patients’ heads, and despite good intentions, the patient perspective is seldom taken into sufficient account. Patient involvement is often met with polite nods but little enthusiasm [3]. ‘We know best what is best for you’ is still a prevalent attitude [4].
For many reasons, it is understandable that patient involvement in health care issues is still more about words than deeds, a major reason being that in the long history of medicine this is only a fairly recent trend and we are simply not yet used to it. Changing habits is always a stubborn process. Furthermore, there are several realistic problems and barriers, including the lack of reliable and valid instruments for measuring patient views [5], [6], the inevitable non responsive bias when recruiting people for this task [6], [7], [8], the high ceiling effects in patient satisfaction scores [7], [9], the subjective character of patient evaluations [10], the heterogeneity of the assessed case mix [7], [11], and the lack of a standardized frame of reference [1], [7]. It is no wonder that many people are still skeptical about the usefulness of patient assessments of the quality of care and are reluctant to implement it at a large scale.
Nevertheless, Governments of most European countries want more consumer involvement [12], [13], [14], [15], [16] and also many doctors are authentic in their wish to involve patients in the way health care should be organised and delivered. This is also reflected in the growing interest in how patients or lay people can be used as teachers [17]. As early as 20 years ago, it was shown that lay persons are well equipped to assess the quality of communication of doctors and that doctors are willing to learn from ‘patients as teachers’. So there seems to be a lot of unused potential which might help to increase the success of medical consultation from a patient perspective, which argues for a more systematic involvement of lay people in quality assessment of medical consultations. Moreover a larger involvement might help lay people to become more fully aware of their own responsibilities in medical consultations. The aim of this study is to generate empirically based ‘tips’ for doctors as well as patients on how medical consultations can become more successful from a patient perspective.
Section snippets
Methods
This study is a part of a multicenter study focusing on lay peoples’ preferences on general practitioner relational/communication style through the use of mixed methods of analysis, qualitative (i.e. focus groups) and quantitative (i.e. rating scales). The study got his name (GULiVer) from the four participating centers: Gent University (Belgium), Utrecht University/NIVEL (the Netherlands), Liverpool University (United Kingdom) and the Verona University (Italy). A description of GULiVer design
Main findings
An overview of the tips formulated by the participants is presented in Table 2.
The tips could be clustered in three different timeframes: before, during and after the consultation. The most mentioned topics or each phase were (see Table 2)
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before the consultation: doctor and patient both have to be prepared for the consultation, the doctor by reading the notes from previous consultations, being aware of the patient's cultural background and keeping an open mind without prejudices; the patient by
Discussion
The study demonstrates that it is feasible to involve lay people in research. It proved to be very easy to recruit the participants, probably partly because of the financial compensation (€150 for a day's work), which was seen as fair and attractive, but also because they had a genuine interest in the topic of the study and appreciated the fact that they could work in a project which was important to them. The participants took their work seriously, were thoughtful and nuanced in their
Funding
This study was partly supported by a grant from Fund PGO (Ministry of Health, the Netherlands), and partly by the authors’ own universities/research institutes. No author has received any financial benefit from research in this study.
Role fund PGO: The funder had no role in the collection, analysis and interpretation of the data, even as in writing the article.
Independence of researchers: All authors declare that they behaved independently of the funding organisation PGO.
Access of data: All
Contributors
JB conceived the idea for the study. JB, IF, FM, MR contributed to the design of the study and collection of the material. JB, IF, FM, MR, and LV contributed to the qualitative analysis and interpretation of the results. All authors contributed to the writing of the paper. JB is the guarantor.
Competing interest
All authors declare that the answer to the questions on your competing interest form are all No and therefore have nothing to declare.
Ethical approval
The project was approved by the Medical Education Research Ethics Committee of the University of Liverpool. Informed consent from all participating lay people was obtained in all four countries.
Acknowledgments
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Fund PGO (Ministry of Health, the Netherlands) for financial support.
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Medical School of Liverpool University for making the videotaped consultations available.
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All lay people who contribute to this project; without their devoted and sincere efforts, this project would not have been possible.
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