Patient involvement in health care will improve quality

Editor—Coulter suggests that patients should be asked to provide detailed reports of their experiences of clinical care during a particular consultation and that they should be asked about what actually occurred rather than to evaluate what occurred.¹ We agree that it is a generalisation too far by Rao et al to state that patients are unable to assess the quality of care they receive.²

A more useful approach may be building working partnerships for care. Coulter mentions this when she stated that most patents prefer doctors who involve them in treatment decisions and those who respect patients' dignity.³ There is much scope for incorporating into routine health care, patients' views on their health needs and their assessment of progress towards treatment goals, particularly in chronic disease. Encouraging patients to become active participants who take responsibility for working towards their treatment goal—for example, by ensuring that their blood pressure is regularly checked—could contribute towards improving quality. In this way partnership between patients and doctors drives the quality agenda.

We recently followed up a cohort of 1000 patients with schizophrenia by assessing patients' views in a structured format. Although treatment alliances are often thought to be more problematic in mental health, we found that patients could contribute accurate information to their care plans on needs and accurately comment on clinical outcomes.⁴ Furthermore, by using patient centred assessment tools, effective alliances developed between clinicians and patients that were associated with reduced admission and other improved pragmatic outcomes. Such approaches are much more likely to improve clinical quality than relying on patient assessed measures of quality in rating-style questionnaires.