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Executive summary
February 2011 sees the second PatientView Quarterly, How we ran the study
which (because of the size of the undertaking)
To support the exercise, PatientView set up a discussion
combines both autumn 2010 and winter 2010-2011
on the PatientView LinkedIn Patients’ Page to ask for
issues.
ideas about the type of questions that should be asked
The second PatientView Quarterly studies the opinions on doctor-patient relationships. The posting attracted
of almost 2,500 international, national or local 25 commentators. Their suggestions were incorporated
patient groups from 35 countries around the world, into the final questionnaire, which covered the
covering over 55 different specialisations (both rare following subject areas:
and common, chronic diseases). The topic on which
the patient groups comment is what patients think of The current state of relationships between patients
doctors—or, more specifically, “how doctor-patient and general physicians, specialists/consultants, and
relationships can be improved”. specialist nurses.
A special effort was made to capture the views of Who in healthcare can legitimately and constructively
patient groups from the following 12 countries or help improve doctor-patient relationships?
regions of the world, and from those in the following
12 specialties: Improving access to health professionals
● The types of improvements in access to general
● Australia [number of completed responses = 60]; physicians (GPs) that are needed by patients
Canada [138]; Eastern Europe [105]; France [80]; ● The types of improvements in access to consultant/
Germany [100]; Italy [110]; the Netherlands [30]; specialists that are needed by patients
New Zealand [55]; Spain [80]; Sweden [56]; the UK
[566]; and the USA [292]. Improving the patient information provided by health
professionals
● Cancer [160]; diabetes [55]; gastro-intestinal [40];
● The types of improvements to information on
heart and circulatory conditions [70]; HIV/AIDS
diagnosis and treatment that are needed by patients
[72]; mental health [170]; multiple sclerosis [35];
● The types of improvements to other categories of
neurological [195]; Parkinson’s disease [30]; rare
health information that are needed by patients
diseases [70]; respiratory [35]; and rheumatological
conditions [55]. Improving doctor-patient communication
© PatientView, 2011 3
Executive summary
How health professionals can gain patient trust that the health professional should provide treatments
which broadly satisfy the patient’s expectations
How health professionals can respect patients’ valuable [mentioned by 33% of respondents].
time
Three measures needed to improve doctor-patient
How health professionals can be made more accountable relations
(both inside and outside the consulting room) The respondent patient groups were told that if
government, insurers and managed-care organisations
How health professionals might improve their prevention were only able to make a single intervention aimed at
practices improving doctor-patient relations, which intervention
What single action do patients want from government would most benefit the patients in their own specialty?
and payers to improve doctor-patient relationships? The respondents’ top three choices are: improving
patients’ quality of life as a result of treatment and
Which pharma companies have a positive record on care [mentioned by 19% of respondents]; improving
helping to improve doctor-patient relationships, and why? the communication and understanding skills of
healthcare professionals [17%]; and improving access
Why pharma can have a negative impact on doctor- to consultants/specialists [14%].
patient relationships
Measure 1: improving patient quality of life
A number of different, but related, questions were
Profiling and mapping respondents asked about how health professionals might improve
the quality of life of patients. Patient groups’ views on
A detailed map and profile of many of the respondent
the subject vary according to their country of origin
patient groups is offered, comprising: their geographic
and medical specialty, but, in general, half (or close
remit; dates when founded; the number of members;
to half) of the groups feel that health professionals
the umbrella organisations to which they belong;
should diagnose and treat without making the patient
their sources of funding; the strength of their current
fight the system to receive the diagnosis, medical
relationships with health professionals; their general
treatment, care or support they need [mentioned by
activities; and their ability to represent patients.
53% of respondents], and health professionals should
The listing allows readers to gain a more in-depth
provide treatments that are most effective for the
understanding of the types of respondents answering
patient—irrespective of cost [49%]. 45% also believe
the survey.
that health professionals who are keen on improving
patient quality of life need to maintain a continuous
relationship with the patient, chiefly by supporting the
Main findings
patient’s management of their own care (including, for
Current doctor-patient relations instance, offering access to multi-disciplinary teams of
With the exception of patient groups in Eastern care providers).
Europe and those specialising in HIV/AIDS, only a
Measure 2: improving the communication skills of health
minority of patient groups believe that doctor-patient
professionals
relations remain traditional and patriarchal. But,
Around half of patient groups would like health
equally, only a minority consider that doctors now
professionals to improve their communication skills
treat patients as equal partners. One notable exception
by ...
are the consultants/specialists (such as neurologists
and geriatricians) who treat people with Parkinson’s ● Regarding the patient as a person, and not as a
disease. 50% of Parkinson’s disease groups say that medical problem. (An exception here are Parkinson’s
consultants/specialists regard patients as equal patient groups; just 35% of them describe this
partners, and act upon that belief. attitudinal change as a desirable goal.)
● Diagnosing and treating only after discussing the
Patients’ treatment goals situation and the treatment options extensively with
The majority [72%] of the respondents identify two the patient. (An exception here are gastrointestinal
main goals that patients have in mind whenever they patient groups; just 43% of them rate this a
visit a doctor or other health professional for treatment desirable goal.)
and care: firstly, that the health professional should
● Providing more patient information. Across
provide treatments which enable the patient to lead a
the entire patient-group sample, the top-three
normal (or near-to-normal) life—even if the patient
choices are: more information on treatment
may have a shorter life expectancy as a consequence
choices [mentioned by 48% of the groups]; more
[mentioned by 39% of the respondents]; and, secondly,
© PatientView, 2011 4
Current doctor–patient relations
Patient groups report that health professionals, though GPs: Percentage of patient groups saying that GPs
not as patriarchal as they used to be towards patients, still are paternalistic in their approach to patients
Treat patient as equals, %
have yet to reach a state of true partnership with patients.
Without such partnerships, noted the respondent patient Germany 17
groups, patients’ clinical outcomes can suffer. New Zealand 18
This survey of the opinions of patient groups asked Italy 25
respondents to assess the state of current doctor-patient
Netherlands 28
relationships. Respondents were offered four possible
responses: traditional and patriarchal; try to partner with Canada 30
patients, but do not always succeed; regard patients as equal Sweden 30
partners, act upon that belief; and vary according to the UK 30
individual health provider.
Australia 31
Only a minority of the respondent patient groups
believe that the current relationships between general Spain 32
physicians or consultants/specialists and patients remain USA 32
traditional and patriarchal (though patient groups in France 33
Eastern Europe, and to a certain extent, groups specialising
Eastern Europe 47
in HIV/AIDS, are not so sure that today’s doctors are less
Source: PatientView survey, 2010.
high-handed and domineering than their predecessors of
previous generations). Equally, however, only a minority of
patient groups consider that doctors treat patients as equal GPs: Percentage of patient groups saying that GPs
partners. The responses received from the patient groups regard patients as equal partners, and act on that belief
Treat patient as equals, %
are outlined in further detail below.
Netherlands 31
Today’s doctor-patient relationships—in different Germany 23
countries France 23
Consultants/specialists are generally considered by patient
Australia 15
groups in various countries to be more paternalistic
towards patients than general physicians (GPs). In most Italy 14
countries, however, consultants/specialists do better than Canada 11
GPs in being able to treat patients as equal partners. Patient UK 10
groups across the world seem to rate specialist nurses as
New Zealand 9
best at forming partnerships with patients. That said, the
health professionals of no countries score particularly USA 8
highly in being able to regard patients as equal partners, Eastern Europe 8
and acting upon it. Sweden 7
Spain 5
Source: PatientView survey, 2010.
© PatientView, 2011 8
What can pharma companies do?
Healthcare companies mentioned by respondents as having had a positive effect upon doctor-patient relationships in their country
Number Number Number
of of of
mentions mentions mentions
© PatientView, 2011 24
What can pharma companies do?
Healthcare companies mentioned by respondents as having had a positive effect upon doctor-patient relationships in their medical specialty
Number of Number of Number of
mentions mentions mentions
The groups offer their reasons why the services of these Canada
healthcare companies have proved valuable in improving Being involved with patients, doctors and researchers
doctor-patient relationships [full details to be found in the Educating both professionals and patients about doctor-
Appendices]. patient relations
Funding condition-specific patient information meetings
The following activities are reported as being performed by at Providing compassionate access to expensive medications
least one healthcare manufacturer (and sometimes several) in Providing patient information about doctor-patient
each country communications
Providing patient information about individual conditions
Australia Providing patient-centred support services
Conducting research Running patient-education meetings about individual
Developing monitoring of prescribed medications conditions
Encouraging patients to offer their views Supporting patient educational opportunities
Flagging unsafe medications Supporting patient group fundraising efforts
Providing GP education meetings
Providing patient education services Eastern Europe
Providing patient information on compliance Educating doctors in partnering with patients
Sponsoring forums and conferences for doctors and General cooperation
patients Monitoring patients’ views
Sponsoring ongoing education Providing material support for the leisure activities of
Supporting patient groups hospitalised patients
Training health professionals Supporting patient group efforts to promote patients’ rights
Supporting patient group efforts to promote the de-
stigmatisation of people with a mental health problem
© PatientView, 2011 25
What patients say Appendix I Countries
Australia
Number of Australian groups responding to the survey: 60
Organisation’s relationship at board and staff levels They are on our staff They are on our board
General physicians 1% 7%
Specialists/consultants 6% 14%
Specialist nurses 12% 7%
Hospital nurses 4% 3%
Primary care nurses 7% 1%
Patient groups in Australia have good contact with health professionals. 84% maintain at least occasional contact with general physicians
(GPs), 78% with specialists/consultants, and 72% with specialist nurses.
© PatientView 2011 41
Appendix II Disease areas
How government, insurers and managed-care organisations can improve doctor-patient relationships—from the patient perspective
Rheumatology patient groups consider that the single most-valuable action which government, insurers, and managed-care organisations
could take to improve doctor-patient relations would be to make efforts to enhance patients’ quality of life as a result of treatment and care.
The second most-important innovation by government, insurers, and managed-care organisations would be ensuring that patients have better
access to consultants/specialists. The third would be to produce initiatives that could increase the communication and understanding skills of
healthcare professionals.
If government, insurers and managed-care organisations were only able to make a single intervention aimed at
improving doctor-patient relations, which intervention would most benefit the patients in your specialty?
[Please tick one option] Rank % of total
Patients’ quality of life as a result of treatment and care 1st 20%
Access to consultants/specialists 2nd 19%
The communication and understanding skills of healthcare professionals 3rd 13%
Health professionals’ ability to provide continuity of care 4th 9%
The information that healthcare professionals deliver to patients = 5th 7%
Patient choices in treatment and care = 5th 7%
Access to general physicians = 7th 6%
The equitable delivery of treatment and care = 7th 6%
Patients’ trust in health professionals = 7th 6%
The accountability of health professionals 10th 4%
Patients’ waiting times = 11th 2%
Health professionals’ preventive services = 11th 2%
Sample comments:
—“A public-awareness campaign.”
—“Caring.”
—“In certain areas, the waiting lists are far too long.”
—”Affordable medical care. Access to health insurance and care.”
—“Change from visit-based payment.”
—“Free access to the best care.”
—“Greater GP awareness of arthritis and the needs of people with arthritis.”
—“Not just a ‘patient’. Be treated as an individual.”
—“Links to supportive advocacy organisations.”
—“Les médecins français sont plus techniciens que conseils.” [“French doctors are more technicians than advice-givers.”]
—“Tempi di attesa per l’accesso alle visite specialistiche.” [“Waiting times for access to specialist visits.”]
—“Die möglichkeit eine einheitliche behandlung innerhalb österreich zu bekommen, jede kasse behandelt die poatienten
anderst.” [“To get the possibility of uniform treatment in Austria, each patient is covered by a fund.”]