9) Patient's Evaluation of Healthcare

Question 1

Why has there been an increased interest in patient satisfaction?

Answer 1

Increasing evidence that how happy a patient is has an effect on how healthy they will be/respond to treatment:

+NHS Plan/Patient Prospectus (account of patients’ views and the action taken as a result)
+Involving patients and the public in healthcare (builds on the patient prospectus as a response to the Bristol enquiry)
+NHS act - health authorities and trusts must “involve and consult” patients and the public
+NHS Outcomes Framework - ensuring that people have a positive experience of care.

Question 2

Suggest the ways we can directly investigate patient’s views on healthcare

Answer 2

• Qualitative methods like interviews, focus groups, observations
• Quantitative methods like surveys, questionnaires, reports

Question 3

Suggest the ways we can indirectly investigate patient’s views on healthcare

Answer 3

• Patient complaints (possibly through patient’s advice and liaison services)
• Parliamentary and Health Service Ombudsman Reports

Question 4

Suggest some things that can cause patient dissatisfaction.

Answer 4

• Poor communication from health professionals (not allowed to report concerns fully, reassurance not conveyed, appropriate advice not provided, inconvenience, waiting times)
• Culturally inappropriate care
• Competence
• Health outcomes

Question 5

Describe the functionalist approach to understanding the patient-professional relationship.

Answer 5

Doctor is all powerful (skills used to help patient, not for personal benefit and get the reward of status, money and autonomy) and the patient is taking the sick role (allowed to be free of responsibilities, social status now demands care, need to seek out expert help and shouldn’t abuse this sick role - not enough knowledge to help themselves)

Question 6

What are some of the disadvantages of the functionalist approach to understanding the patient-professional relationship?

Answer 6

• Sick role not well thought out – some patients can not get better.
• Some patients illegitimately occupy the sick role.
• Assumes patients are incompetent and must have a passive role don’t have expertise doctors do.
• Assumes rationality and beneficence of medicine

Question 7

Describe conflict theory in the understanding of the patient-professional relationship.

Answer 7

• Doctor’s control is not only the product of professional values or technical expertise, but also due to the fact that the doctor holds all the bureaucratic power (GP deciding whether you get to go to hospital)
• Lay ideas are marginalised and discounted (doctor knows best)
• Dependent on medicine, lose self-reliance and become sick

Question 8

What are some of the disadvantages of conflict theory in the understanding of the patient-professional relationship?

Answer 8

• Patients are not always passive, can exert control e.g. via non-adherence or use of complimentary therapies
• Patients may appear submissive in consultation but assert themselves outside of this
• Medicalization of things leads to inappropriate respect for that thing (ADHD)

Question 9

Describe interpretivism/interactionism in the understanding of the patient-professional relationship.

Answer 9

Focus on the meanings that both parties give to the encounter - informal, unwritten rules govern almost every aspect of social life. Certain expectations about how the consultation should go.

Question 10

How is the patient centred/partnership model different to the other models suggested to explain the patient-professional relationship?

Answer 10

• Functionalism, conflict theory and interpretive/interactionism are all explanatory, they all try to explain the patient-professional relationship
• Whereas, patient-centred/partnership is aspirational - idea that the two can come to an agreed plan they are happy about.

Question 11

Describe the patient centred/partnership model in the understanding of the patient-professional relationship.

Answer 11

-Aspiration that patient-professional relationships can be less hierarchical and more cooperative if the patients’ view is taken more seriously. (ICE)

Question 12

Describe the function of the Patient Advice and Liaison Services (PALS)

Answer 12

• On the spot help about health services which listens to patients’ concerns, suggestions and experiences
• Early warning system by identifying problems or gaps in services
• Provide information about the NHS complaints procedure

Question 13

Describe the role of Local HealthWatch.

Answer 13

Independent networks of individuals or community groups with the aim to ensure that each community has services that reflect the needs and wishes of local people.

Question 14

What are some of the disadvantages of patient centred/partnership in the patient-professional relationship?

Answer 14

• People sometimes want to be told what to do rather than contributing
• When there safety/their children’s safety might be comprised - might need to tell them what to do.