Patient Evaluations

Question 1

Why ask for patient opinions?

Answer 1

Pt satisfaction is important outcome
Humanitarian and ethical
Rejection of paternalism
Increased regulation of health services

Question 2

What were the aims given in the latest White Paper?

Answer 2

Strengthen collective voice of pts
Widespread use of pt experience surveys and real time feedback
Use complaints to assess quality of service

Question 3

How do we usually ask for pt feedback?

Answer 3

Friends and family test (would you recommend)

Rate and comment on NHS choices

Question 4

What is Healthwatch England?

Answer 4

National consumer champion in health care
Increase voice of user
Must seek views of local people and pass on to those responsible for commissioning or providing care

Question 5

What is PALS?

Answer 5

Patient advice liaison services

NHS trust based

Question 6

What do PALS help with?

Answer 6

Health related Qs
Resolve pt concerns or problems with NHS
Help pts get more involved in own care
Give info on NHS
Handle complaints

Question 7

What is the health service ombudsman?

Answer 7

Sits above other health care services

Undertake independent investigations into complaints if needed

Question 8

Give some common causes of pt dissatisfaction with regards to interpersonal skills

Answer 8

Poor communication from HCPs
Pts not able to report their concerns 
Full Hx not taken 
Staff do not convey reassurance 
Staff do not provide appropriate advice

Question 9

Give some common causes of pt dissatisfaction with regards to content of care

Answer 9

Inconvenient 
No continuity eg. With doctor
Poor food/bedding
Waiting times
Culturally inappropriate 
Competence

Question 10

What are the challenges when the NHS try to respond to pt complaints?

Answer 10

Pt views may not be reasonable/rational
Locating responsibility
How much resource can be spent?
Opportunity cost

Question 11

What are the 4 sociological approaches to doctor-patient relationships?

Answer 11

Functionalism
Conflict theory
Interpretivism/interactionism
Patient-centred

Question 12

Describe a functionalist approach to the dr-pt relationship

Answer 12

Falling ill is a socio-cultural experience
Lay people do not have technical competence to remedy - placed in state of helplessness
Medicine restores health - restores social equilibrium

Question 13

What are the rights/duties of the sick role?

Answer 13

Legitimate reason to be freed of social obligations
In a situation of dependence: need medical care
Should want to get well and not abuse their exemption from normal responsibilities
Expected to seek out the proper help and cooperate with HCPs

Question 14

What is the doctor’s role in the functionalist approach?

Answer 14

Tending to sick in society
Should use skills for benefit of pt not own self
Be objective and non-discriminatory
Granted intimate access to pts

Question 15

What are the criticisms of the functionalist approach?

Answer 15

Sick role not well thought out - some pts cannot get better
Assumes pts are incompetent and must have passive role
Assumes rationality and beneficence of medicine
Doesn’t explain why things go wrong

Question 16

Describe the conflict approach to dr-pt relationship

Answer 16

Medical dominance and suppressed conflict
Doctors holds professional values, technical expertise and bureaucratic power
Doctors decide who is and isn’t ill
Pt has little choice but to submit to doctor
Medicine has pathologised some aspects of life eg. Birth

Question 17

What are the criticisms of the conflict theory?

Answer 17

Portrayal of pts and doctors as inevitably in conflict - correct?
Pts not always passive - can exert control
Pts can seek to medicalise issues too

Question 18

Describe the interpretive/interactionist theory to dr-pt relationship

Answer 18

Focuses on meanings both parties give to the encounter and how they conduct themselves
Patterns looked at
Informal, unwritten rules

Question 19

Describe patient centred approach to dr-pt relationship

Answer 19

Aspirational 
Cooperative - mutually agree on Mx 
Pt views need to be taken seriously, pt and HCP as equals
Seek context to each pt 
Both dr and pt need to share info

Question 20

What are the challenges to pt-centred medicine?

Answer 20

Pt/doctor may not want to share in decision making
Unknown consequences of involvement?
When should the power of pts be limited?
Who has final responsibility?
Is there time to achieve this in a consultation?