MEDICAL MATTERS: 'Sir Lancelot had personality like an avalanche and a downright bedside manner ... His suggestion on the removal of his patient's organs never met with their objection, writes Dr Muiris Houston.
The more he did to them the greater the compliments that resulted from his interference, the longer the number of supplementary operations he had to perform to retrieve his errors, the more they thanked him."
So wrote Richard Gordon, in his 1952 classic Doctor in the House. Those of you who have read the book or seen the film will remember Sir Lancelot as a giant of a man, who bellowed instructions at both staff and patients. Not for him the intricacies of the doctor-patient relationship. Like many eminent consultants of the time it was a case of the doctor telling the patient what was wrong and the patient listening meekly while treatment was unilaterally prescribed.
Thankfully doctor-patient communication has moved on. But as the Irish Society for Quality and Safety in Healthcare (ISQSH) pointed out recently, patients need to assume a much greater role as managers of their own health.
"Being patient centred involves much more than being dedicated and caring. It's a different way of thinking and behaving, where doctors and patients work together as true partners," the society said at the launch of a booklet Let's Talk, by the Minister for Health, Ms Harney recently.
The front of the booklet says "don't lose your voice, exercise it regularly"; it includes tips for improving the healthcare you receive as well as suggesting questions you may wish to ask the professionals who are looking after you. They include:
Can you tell me more about my condition?
Do you have any information I can take away with me?
Why do I need to have this particular test?
Are there other treatments for this condition?
What are the risks of treatment?
What is likely to happen if I don't have this treatment?
The society says major changes are taking place in the nature of social and professional relationships. "The status gap that previously existed between professionals and patients is being eroded by improvements to education and access to information through the media and the internet."
This is undoubtedly the case; but perhaps the most important driver of change is the need to move to a more equal relationship between doctors and patients. It is simply no longer acceptable for doctors, no matter how senior, to talk down to patients. The Sir Lancelot Spratts have no place in modern Irish healthcare.
Another reason why we all need to become more active in our care is the need to avoid error. Medication errors are the most common form of healthcare mistake and the new booklet offers the following advice.
When you get your medicine, read the label. Make sue it is what your doctor ordered for you.
Ask your doctor or pharmacist the purpose of the medication.
If you are taking multiple medications, ask your doctor or pharmacist if it is safe to take these medications together. This holds true for vitamins, herbal supplements and over the counter drugs too.
What are the common side-effects? What should I look out for? How long before the medication starts to work?
A crucial piece of advice in the guide, and one that can readily lead to serious error is not to assume that "no news is good news" where investigations are concerned. Always get the results of any test or procedure and ask what they mean for your continuing care.
An editorial in last week's Lancet also touched on patient involvement in their care. Commenting on the self-management of chronic illness it said the process of individualisation remains at the heart of clinical practice.
"The job of the clinician is to work from a common core of knowledge and to individualise care ... First tell the patient the evidence about their condition. Second, allow the patient to reflect on the options presented and relate those options to the values he or she places on benefits or harm. The third aspect of individualisation, perhaps the most difficult and perhaps the one that should be dealt with first, is to individualise the style of consultation according to the preference of the patient," it said.
This is highly relevant advice to those of us privileged to look after patients. The kind of prompting we will get from patients who read the ISQSH booklet, will also help move doctors from any remaining vestige of autocracy.