Patient partnership – what does the future hold?

Carmen Wong 黃嘉雯

HK Pract 2017;39:33-34

As family physicians, we are partners with patients in care. We sift through the intricate details of the patients’ plethora of symptoms, the texture of their individual psyche and the fabric of their family, social and personal lives to identify health and social issues we can resolve. We journey through the ups and downs, successes and failures of fad diets, exercise endeavours, through illness and recovery. There are days we are exhausted as we speedily navigate consultation after consultation. We may become disillusioned at the extent of the problems or the slow pace of change. We may be frustrated at ourselves and sometimes at our patients.

A recent encounter with Fiona Godlee (Editor in Chief, BMJ and former GP) has enlightened my perspective on the future of patient partnership and how this can help us as family physicians do an even better job. Part of our frustrations with patient encounters may be one of misinformation. A study of patients with rheumatoid arthritis¹ showed that tiredness was their main concern about disease control and treatment, whilst doctors tend to emphasise joint stiffness and pain. The lack of research and treatment strategies for tiredness even when identified can leave us helpless. Perhaps the parameters of quality of care of doctors and patients are mismatched and as our clinical systems and internal checklist continually update (and elongates) to ensure patient safety, we may be straying further from what patients need. The lack of patient participation in research, patient agenda in setting the research question and rigorous (and restrictive) research methodologies may account for the priorities we see leading to a poverty of guidance in the ambiguity of concerns and queries we encounter, e.g. multimorbidities versus single diseases. The inclusion of patient opinions on research design, implication and dissemination should be paramount and a recent ‘patient included’ accreditation given for research, conferences and patient information resources that acknowledge patients in the process is a welcoming start.² Meanwhile we are likely to see more impactful research on patients and communities in Hong Kong as universities are changing the way research efforts are evaluated sharing similarities with the United Kingdom Research Excellence Framework 2014.³

Training in patient partnership is also essential to equip doctors and other professionals with the necessary skillset. The Picker Institute⁴ emphasises the need to engage patients more fully in their care and in supporting self-care, to learn the theory and practice of developing health literacy and to enable shared decision-making through skilled communication. There is more that we can do within the undergraduate curriculum, e.g. inclusion of simulated and real patient formative and summative assessments, inclusion of patient narratives, increase exposure to vulnerable groups and populations with variable health literacy,...etc. These should also extend to postgraduate programmes with innovative educational models.

Shared decision making and health literacy may also be aided by patient held records. As professionals, we know the importance of lifelong learning and patients' lifelong learning on their chronic disease and self-management can be viewed similarly. We all experience the cognitive dissonance we have when we prefer to spend more time in giving explanations and checking understanding but are conflicted as we are time pressured with a waiting room of patients to see. The consultation time is finite and our efforts limited. Territory wide endeavours, e.g. commissioning nongovernmental organisations in patient empowerment programme for diabetic patients⁵ recognises the need for a multidisciplinary effort in tackling the agenda and the pioneering of innovative practices. The use of peer education in health may be the way forward as illustrated by Health talk, a website dedicated to patients' narratives in health.⁶

Patient involvement, engagement and learning can be a weary task, and certainly one we face on a daily basis as family physicians. The frustrations we have are real, the patients expressed needs are true and we need not tackle this alone. I am encouraged that the climate is changing and perhaps we will soon see novel research and innovation that will help us and patients reach that sweet spot.