Monday, 25 April 2011

What do patients really want?

‘Nothing about me without me’ is one of the core messages of the planned NHS reforms with the aim of ‘putting the patient at the heart of everything we do’.

But what do patients REALLY want? I suspect that no amount of market research or in-depth questionnaires could give a definitive answer as we are all individuals with a varying combination of needs and fears. This list is my attempt at summarising what those of us associated healthcare should be considering for our patients.

Information: This immediately brings us to dodgy ground. How much information? Information about diagnosis, treatment options, prognosis – the list goes on. But a fundamental principle should apply in all cases. Take your lead from the patient and their carers. Some patients want to know everything – from the gory details of surgery to recovery statistics. Others are happy to trust their medical team and really would rather not know any detail. Clinicians are now beginning to accept that patients will search the internet for answers and may often miss the point so time must be taken to give them the right facts.

Choice: But how much choice? I have spoken to many patients who like the thought of having a choice of hospital and treatment but ultimately find too much choice burdensome. With choice must also come education and how much time is available for this? What about the ability for patients to take on board the information needed to enable them to make an educated decision? Patients would normally opt for a hospital nearby for surgery – or prefer to go to their GP practice for a day case. But what if the centre of excellence is a hospital further away, or the practice has little experience of providing procedures? Choice can, in some cases have a detrimental effect on the patient so must be carefully handled.

To be listened to: Tears of frustration among patients and carers are so often the result of the feeling that they are not being listened to. I would love to see listening skills and communication skills included in every continuing professional development programme for all patent-facing staff.

Easy access to GPs: Patients want to see their GP on the same day if there is a cause for concern. Good practices keep a limited number of daily slots for semi urgent consultations. Other good practices have a ‘turn up and wait’ system where patient understands that they may have to wait a few hours but they are guaranteed to see a GP that day. That’s what patients want. Effective diary management at primary care centres will have an instant impact on reducing emergency department traffic.

Decent out of hours primary care cover: Good telephone advice or a night time home visit by a GP reduces patient anxiety and of course improves patient outcomes. A basic, fundamental requirement that is delivered with horrifying variations of quality.

Continuity of care:  The care for patients with long term conditions to be coordinated by their GP to be cared for in their community. (This has been added to my list as suggested by @mellojonny)
Clean hospitals: Spotlessly, measurably, consistently super-hygienic is what patients hope for but don’t always expect. This must be the norm.

Courtesy and kindness: My grandmother used to say ‘a little kindness goes a long way’ And it does. However busy, stressed, overworked, underpaid or generally grumpy a doctor/nurse/porter/therapist/receptionist is – they are working in an environment where people are often in pain, upset or frightened. They deserve to be treated with respect and care. Always.

Parking or easy access to public transport: This is a constant cry of patients and their carers. So often a stoical relative will finally crack as they drive around a hospital or health centre car park desperate for a parking space.

Reduced waiting times for procedures and fast track appointments for suspected cancer diagnosis. Of course that’s what everyone wants.

And finally – a matter close to all our hearts…
Decent hospital food and someone to help frail patients eat: The heartbreaking stories of elderly patients unable to feed themselves becoming malnourished in hospital must stop. Good food improves patient morale. Hospital food is nearly always high on a patient’s wish list.

If our health system can address all of the above – I think we will have pretty much cracked it!


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