Session 9 - Patients’ Evaluations of Healthcare and Relationships between Patients and Professionals Flashcards
Give four parts of policy background which explains the growth of interest in patient’s view os health sevices
1) NHS patient prospectus (200)
- An accoubt of patients views and the action taken as a result
2) Involving patients and the public in healthcare
- Builds on patients prospectus
3) Health authorities and trusts must involve and consult patients and public (2006)
- Decisions about services
4) NHS outcomes framework (2012/13)
Ensuring that people have a positive experience of care
Give three main organisations which recruit patients viewsd
LINKs
Local involvement Networks
PALS
Patient advice and liason services
Parliamentary and health service ombudsman reports
What is LINK?
o Independent networks of individuals or community groups
o Aim to ensure that each community has services that reflect the needs and wishes of local people.
o Making recommendations to those who plan and run services.
What is PALS
o On the spot help about health services.
o Listen to patients’ concerns, suggestions and experiences
o Provide an early warning system by identifying problems or gaps in services
o Provide information about the NHS complaints procedure
Single complains system (since 2009)
Focuses on satisfactory outcomes
Risk assessment to deal quickly with serious complaints
Independent investigators if needed
Specialist advocates for those with special needs
What is Parliamentary and Health Service Ombudsman Reports?
o Independent investigations into complaints that NHS has not acted properly or fairly in England
o Ultimate, independent view of what has happened
Give two ways of directly investigating patients views
Qaulitative methods
Quantitative methods
What qualitative methods are used to directly investigate patients views?
What is it good at? (1)
o Interviews, focus groups, observations
o Successful at identifying patients’ priorities and how they evaluate care
Give three benefits of using quantitative methods?
o Anonymity more easily guaranteed
o Relatively cheap and easy (Less staff training required)
o Allows of monitoring of performance
Give three reasons is better to use national surveys rahter than locally develop DIY instruments
Lack comparability
Many do not have proven reliability
Tend to find higher levels of satisfaction
Give three crticicisms of patients views
Not resonable
Unrealistic expectations of heatlhcare
Give six big causes of complaints in NHS
Poor commiunication from health professionals Inconvenience, waiting times Hotel aspects of care Culturally inappropriate care Competence Health outcomes
Give an advantage and disadvantage of using patient based outcomes to assess doctor’s performance?
Advantages
o Ultimately care is provided to patients, so they should feel it is adequate
Disadvantages
o Patients may not provide an objective view. As they are the patient, their view will naturally be a selfish one as they look to improve their own care.
o Not applicable on the national scale.
Give four different approaches to understanding the patient-professional relationship
- Functionalism
- Conflict theory
- Interpretivism / Interactionism
- Patient-Centred / Partnership
What is funcitonalism
Assymetrical role between doctors and patients
- Doctor is powerful, patient adopts a sick role
What is a sick role?
o Legitimate reason to be freed of social responsibilities and obligations.
o Placed in a situation of dependence: their new social status demands care
o Should want to get well and not abuse their legitimised exceptions from normal responsibilities
o Expected to seek out the technical help in the role of the physician and cooperate with them in the healing process
What is doctors role in functionalism?
o Tending to sickness in society
• Use skills for the benefit of patients, not in their own self interests; be objective and non-discriminatory
• Granted intimate access to patients, autonomy, status, financial reward
Give three criticisms of the functionalist approach
o Sick role not well thought out – some patients can not get better. Some patients illegitimately occupy the sick role.
o Assumes patients are incompetent and must have a passive role.
o Assumes rationality and beneficence of medicine
What is conflict theory?
Doctors control also comes from possesion of bureaucratic power. Have monopoly on defining health and illness
Give three downsides to doctors with beureacratic power in conflict theory
o Lay ideas are marginalised and discounted
o People become dependent on medicine, lose self-reliance and become sick
o Idea that “medicalization” of childbirth has resulted in loss of control for women
Give three criticisms of conflict theory
o Is this portrayal of the patient-doctor relationship accurate?
o Patients are not always passive, can exert control e.g. via non-adherence or use of complimentary therapies
o Patients may appear submissive in consultation but assert themselves outside of this
What is the interpretive approach?
These approaches focus on the meanings that both parties give to the encounter. Informal, unwritten rules govern almost every aspect of social life.
o Every medical encounter is framed by a set of expectations
o Doctor and patients avoid all matters “not fitting” with the ideal of patient and doctor
o Each party orients to an idealised conception of the encounter
What is patient centered model?
The aspiration that patient-professional relationships can be less hierarchical and more cooperative if the patients’ view is taken more seriously. It explores the patient’s ICE and seeks an integrated understanding of the patients’ world.
o Shift from traditional ‘professional-centred’ ‘patient-centred’ model
Give three advantages of patient centred model
o Emphasis on equality in the relationship
o Enhances prevention and health promotion
o Enhances the continuing relationship between the patient and doctor
What is shared decision making?
o Doctor and patient both involved in treatment decision making process
Express treatment preferences
Treatment decision is made which doctor and patient both agree on
o Doctor and patient both share information with each other
o Patients can contribute their concerns and priorities in relation to presenting problems
Give thrtee explanatory approaches to doctor patient relationship, and one aspirational
- Functionalism – Explanatory
- Conflict – Explanatory
- Interpretive/Interactionism – Explanatory
- Patient-Centred/Partnership – Aspirational
