I first heard of Angela Coulter as being a member of the G10 group on innovation and the provision of medicines. How did I and others working with patient organisations feel? Put out? No, more than that, if I'm honest—frankly hostile. Why was it that a chief executive of the Picker Institute Europe, an academic for God's sake, should be called on to represent the patient's perspective when there are plenty of individuals working with patient groups who could bring the needs of patients to the political table? So, having recognised my inner feelings, I began to read her book with prejudice, curiosity, and finally respect.
Figure 1.
Angela Coulter
The Nuffield Trust, £5.99, pp 121 ISBN 0 11 703056 2
Rating: ★★★
The Autonomous Patient is well written, well constructed, and thought provoking. Professor Coulter shows that most people want to be involved with their care plans and need written materials to help them with decision making. However, if this is to be done well, there must be training programmes for health professionals to ensure that they can cope with the informed patient.
She examines compliance and concordance. All of us understand that, for medicines to be effective, we must obey the instructions on the label and comply; but this word “concordance”—what does it mean? Simply that patients discuss with their doctor, as equal partners, whether this medicine or that medicine is really suited to them, talking about the side effects, and weighing up the risk factors in making the final choice. This is a new way forward for doctor and patient, a route that it is only possible to follow when the patient has good, clear information and the doctor has the time to listen. When it works, this therapeutic alliance might lead to better management, but there is no doubt that more research is needed.
In The Resourceful Patient, Muir Gray looks at the shifting balance of power between doctors and patients over the past 200 years and at the current decline of medical authority, a trend that is not particularly lamented by clinicians nor welcomed by all patients. He shows that for some people, being ill in the 21st century is, with the aid of the internet, to become experts in their illness.
Different patients have different needs and the same patient may have different needs at different stages in his or her life. Some patients want a sharing partnership with their doctor to assess risk; others understand prescribing costs and their implications for budgets; and others want the paternalistic model. Each of these models has a place.
Figure 2.
The Resourceful Patient
J A Muir Gray
eRosetta Press, £14.50, pp 154 ISBN 1 904202 00 4
Available free online at www.resourcefulpatient.org
Rating: ★★★
Without in any way being defensive, Dr Gray shows that a doctor's job is not easy and is about appraising options—whether to go for active surveillance or active intervention, balancing this against public expectation that the doctor should do something.
The development of the resourceful patient or the informed patient or the expert patient—whatever term is used—is an unstoppable trend and should be seen as an exciting challenge, Dr Gray argues. There is no doubt that the way forward is to develop better communication skills on both sides. There needs to be investment to help clinicians master skills, knowledge, and attitudes that will enable them to be more patient focused. Equally there must be investment to help society develop more resourceful patients. One without the other will be a wasted effort, he says.