Session 9 - Patients’ Evaluations of Healthcare and Relationships between Patients and Professionals

Question 1

Give four parts of policy background which explains the growth of interest in patient’s view os health sevices

Answer 1

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

Question 2

Give three main organisations which recruit patients viewsd

Answer 2

LINKs
Local involvement Networks

PALS
Patient advice and liason services

Parliamentary and health service ombudsman reports

Question 3

What is LINK?

Answer 3

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.

Question 4

What is PALS

Answer 4

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

Question 5

What is Parliamentary and Health Service Ombudsman Reports?

Answer 5

o Independent investigations into complaints that NHS has not acted properly or fairly in England
o Ultimate, independent view of what has happened

Question 6

Give two ways of directly investigating patients views

Answer 6

Qaulitative methods

Quantitative methods

Question 7

What qualitative methods are used to directly investigate patients views?
What is it good at? (1)

Answer 7

o Interviews, focus groups, observations

o Successful at identifying patients’ priorities and how they evaluate care

Question 8

Give three benefits of using quantitative methods?

Answer 8

o Anonymity more easily guaranteed
o Relatively cheap and easy (Less staff training required)
o Allows of monitoring of performance

Question 9

Give three reasons is better to use national surveys rahter than locally develop DIY instruments

Answer 9

 Lack comparability
 Many do not have proven reliability
 Tend to find higher levels of satisfaction

Question 10

Give three crticicisms of patients views

Answer 10

Not resonable

Unrealistic expectations of heatlhcare

Question 11

Give six big causes of complaints in NHS

Answer 11

Poor commiunication from health professionals
Inconvenience, waiting times
Hotel aspects of care
Culturally inappropriate care
Competence 
Health outcomes

Question 12

Give an advantage and disadvantage of using patient based outcomes to assess doctor’s performance?

Answer 12

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.

Question 13

Give four different approaches to understanding the patient-professional relationship

Answer 13

1. Functionalism
2. Conflict theory
3. Interpretivism / Interactionism
4. Patient-Centred / Partnership

Question 14

What is funcitonalism

Answer 14

Assymetrical role between doctors and patients

- Doctor is powerful, patient adopts a sick role

Question 15

What is a sick role?

Answer 15

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

Question 16

What is doctors role in functionalism?

Answer 16

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

Question 17

Give three criticisms of the functionalist approach

Answer 17

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

Question 18

What is conflict theory?

Answer 18

Doctors control also comes from possesion of bureaucratic power. Have monopoly on defining health and illness

Question 19

Give three downsides to doctors with beureacratic power in conflict theory

Answer 19

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

Question 20

Give three criticisms of conflict theory

Answer 20

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

Question 21

What is the interpretive approach?

Answer 21

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

Question 22

What is patient centered model?

Answer 22

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

Question 23

Give three advantages of patient centred model

Answer 23

o Emphasis on equality in the relationship
o Enhances prevention and health promotion
o Enhances the continuing relationship between the patient and doctor

Question 24

What is shared decision making?

Answer 24

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

Question 25

Give thrtee explanatory approaches to doctor patient relationship, and one aspirational

Answer 25

1. Functionalism – Explanatory
2. Conflict – Explanatory
3. Interpretive/Interactionism – Explanatory
4. Patient-Centred/Partnership – Aspirational