One of the most important health care issues was the relationship between the patient and the health professional, Dr Muir Gray (chairman, Electronic Library for Health) told the PAGB conference. A new paradigm was needed where the well informed patient rather than the clinician was the driver of change, he suggested.
Patients needed to know about the risks, benefits and limitations of any health care intervention, and, if they so chose, to share in the decision-making process. In a United States breast cancer study, one third of women had wanted the doctor to make the decision on treatment, one third had wanted to make the decision themselves, and one third had wanted to share the process.
The GP surgery was the "heartland" for decisions about treatment, but both partners - the doctor and the patient - needed to shift their attitudes in the consultation. The doctor's role was to apply the results of clinical trials to the patient, while the patient, who had responsibilities as well as rights, had to understand the limitations of health care technology. Patients wanted health care, but they were critical when it went wrong. Moreover, the three most important words for doctors were "I don't know", because it was completely impossible to keep up to date with the medical literature.
Health professionals in the United Kingdom were among the least paternalistic and most open in the world and were leaders in self audit. The problem was that investigating the quality of interventions revealed problems and caused newspaper headlines. Such scandals did not appear in the French and German newspapers because the French and Germans did not measure what they were doing. In Britain, said Dr Gray, "we have never been more effective, and never more criticised."
What was needed now was not so much in terms of clinical change but a systems change which would ensure easy access to information for both patients and clinicians. Patients needed to be given the responsibility to conduct their own journey through the health care system.
Although some patients would still rely on their doctors to make a decision, facilitating patients to make their own decisions was the only way of retaining their faith in the NHS, Dr Gray concluded.