Although glad that our editorial1 gained such a quick response in the Journal's Back Pages,2 we were sorry to find that we had been unable to explain our apparent perversity to Dr Jefferies' satisfaction. To restate our argument:
Patient-centredness has to be our goal. If we fail to understand patients' concerns and perspectives we cannot provide appropriate and effective advice and management, resulting in frustrated doctors as well as unsatisfied patients.
More evidence of better outcomes from patient-centred practice has just appeared.3,4 Policy makers have at last taken up the idea that to focus on patients' concerns may provide better health care, but they necessarily deal with broad issues. It is up to us to work out the implementation details; for this we need better research methodology and training. Patient-centredness is hard to measure, so it is difficult to train and reward doctors for good practice. We welcome recent attempts to study it.
We were very surprised that McLean and Armstrong5 emphasised the cost of their training intervention at the expense of the impressive and significant gain in patient satisfaction. Even so, we agree that it is important to debate the meaning of a cost that is apparently non- significant in statistical terms. Misunderstanding by patients is so common that the videotape suggestion seems valuable.6 We don't suggest that these interventions5,6 be widely implemented on the evidence presented, but they are worth considering as we try to improve clinical practice.
It is important that we still debate the issues of what patient-centredness really means and how we can get better at it. If it could be measured then good practice could be rewarded appropriately. This might even bring added resources to general practice, bearing in mind the current policy context of the NHS.
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