What patients want
Introduction
In the shifting scene of patients’ advocacy for centuries, doctors have considered themselves to be the patient's best advocate. Without reflecting too much or too critically on their own role in the medical process, they did their work based on a firm belief that everything they did was always in patient's best interest. This started to change when other disciplines entered the medical arena with their research and teaching activities. In the seventies, sociologists, such as Freidson [1] and Illich [2] unveiled the doctors’ dominance and the power struggle that sometimes takes place in medical consultation rooms. They showed that the interests of doctor and patient may not always coincide. The thousands of citations to their work demonstrate that their then controversial view on the medical profession touched a raw nerve in many people.
Moreover, with the growth of medical knowledge and technology, it became clear that the patient's voice is not automatically heard when doctor use their conventional way of communication, which used to be characterized by structured history taking. As a reaction, medical psychologists became involved in medical education and showed doctors that listening to the patient might be more effective than asking questions in the diagnostic phase [3]. Communication training programmes were developed, initially inspired by Carl Rogers’ concept of unconditional regard, with its emphasis on providing space for the patient, active listening and showing empathy [4]. Patient-centered medicine became the new buzz-word, and was defined by Henbest and Stewart [5] as ‘care in which the doctor responds to the patient in such a way as to allow the patient to express all of his/her reasons for coming, including symptoms, thoughts, feelings and expectations’ (page 28). Note that in these early years the emphasis of communication training was on the first part of the medical consultation, when the agenda still had to be made.
Fairly recently, the scope of most communication skills training has been broadened to incorporate the second part of the medical consultation, where treatment decisions are made and implemented [6]. Parallel to these conceptual developments, the training in communication skills itself became more comprehensive, covering all relevant functions of the medical consultation: (1) fostering the doctor-patient relationship (2) information gathering, (3) information giving, (4) (shared) decision-making, (5) strengthening patient self management and (6) attending to emotions, as presented by de Haes and Bensing [7]. In the meantime, a new generation of professionals stood up as patient advocates. This time the psychologists, nurses and doctors who were involved in teaching communication skills were the ones who claimed to know what patients want. The question remains whether these professionals indeed are better patient advocates than doctors are.
Section snippets
Time to listen to the patients’ voice
The idea for this special issue of Patient Education and Counseling was born during a scientific meeting in Verona, where professionals had a fierce debate on what patient-centered medicine really is. The guest-editors of this special issue were listening to this discussion and asked themselves the logical but unspoken question: where is the patient in this debate? What do patients themselves really want? Professionals claim to be the patients’ advocate, and maybe they are. But why don’t we
Fostering the relationship
Many of the qualitative papers in this special issue have been performed in oncological settings. Unanimously these show the importance of a good doctor–patient relationship. Walczak's et al. [11] paper focuses on the patient perspective when discussing end of life issues. The authors show that talking about acceptance, readiness and adjustment to the inevitable situation may assist patients in helping to plan care, achieve more control and enjoy an optimal quality of life. The patients of this
Information giving
The quantitative studies in this special issue generally cover a number of topics, but – compared to the qualitative studies which tend to focus on ‘the soft side of medicine’ – the attention to the function ‘information giving is striking. Mismatch is a popular topic. Although a large part of the medical consultation is spent on medical information giving, this information does not always fit with patients’ needs. In the paper by Kelly et al. [19], it is reported that 40% of a sample of 141
General guidelines versus patient differentiation
Most communication training programs tend to train general communication skills, based on general guidelines about what constitutes ‘good’ communication. However, several papers in this special issue show that patients are different and need or prefer different communication styles in similar situations. We already referred to Smets’ study on the influence of patient characteristics on their report on trust in the physician: the more anxious patients were the less they fully trusted their
Out of the box: patient centered communication from a different angle
Marketing research is a sector which is specialized in differentiating between various target groups. Closely linked to the private sector, which needs advanced knowledge how to reach different target groups, communication researchers, with their tendency to general guidelines might learn from unusual alliances between academics and marketing specialists. Kravitz et al. [27] paper about a collaborative project involving academics and marketing people demonstrates that such initiatives, although
Conclusions
The papers in this special issue lead to a number of conclusions. Some of these are not new, but are important to mention, because they confirm the existing literature, and thus the validity of views of a number of professionals who claim to be the patients’ advocate. The strong preference and the need for an empathic doctor who is willing to take the time for listening to the patients’ story, and is prepared to seek for tailored solutions is a nice example of a quality indicator which is
Acknowledgement
We would like to thank the authors for their patience. We are very grateful to Catherine Newman (Elsevier) for her continuing great support.
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