Roubado na Lancet:

“How to improve the NHS? Just complain more”, so ran the headline of an interview with Liam Donaldson, the UK's Chief Medical Officer, published in the UK newspaper The Times on July 19. Donaldson wants patients' feedback to assume a similar role to that of customer feedback in big supermarket chains. No bad apples, no goods beyond their sell-by date, and as much choice as possible. “We want people to have high expectations because it's only by stretching ourselves and being ambitious … that we find ways of doing things differently”, he explains.
This interview coincided with the launch of his fourth annual report, which includes a curious choice of topics as disparate as tobacco smuggling, food in the public sector, prevalence of gastroschisis, and patient safety alerts in the NHS. The report claims to draw attention to the major challenges in health and health care facing the UK, particularly where current action is not sufficient to fully address them. One of the most important challenges facing modern medicine, however, is at best left unheeded, at worst severely undermined, by the emphasis on a patients' complaints culture: the need to strengthen the patient-doctor partnership.
Patients' trust in the medical profession has been seriously shaken by high-profile cases of medical negligence and crime, such as those of the Bristol cardiac surgeons and of Harold Shipman, respectively. And press interest has continued to focus on doctors accused of incompetence, leading to a distorted and false picture that suggests widespread untrustworthiness. In reality, most doctors are extremely hard working under often difficult conditions. Many health-care workers face daily threats and verbal and physical abuse by patients with expectations that are simply beyond what today's health service can provide.
Doctors and governmental organisations need to do everything they can to rebuild the public's trust in medicine. Safeguards need to be in place to recognise problems early. When problems occur, they have to be dealt with swiftly and fairly by appropriate due process. Patients should have adequate information about their care and medication, and easy, not target-driven, access to medical services. An important part of rebuilding trust is, however, lacking. To achieve the right balance, the Government needs to send a stronger signal that the medical profession is valued and that its skills, knowledge, and professionalism are recognised as key to peoples' health. Instead the message continues to be a divisive one: the NHS should be patient-led, patients need to complain more, people should have choice and control over the care they get. And doctors are obstacles to this patient-friendly agenda.
The UK Healthcare Commission released its annual report on the State of Healthcare 2005 on July 18. The report covers three main questions: do people receive effective health care; do people have enough control over the care they receive; and do some people get a better deal from health care than others? All these questions are explored from the patients' point of view. The report concludes that significant improvement is still needed in relation to the level of patient involvement in decisions about health care. And that improvements to services will hopefully continue with patients' needs, rather than the needs of those delivering services, in mind. Surely, a well-functioning health-care system should have the needs of those getting care and those delivering it in mind. Nowhere is this acknowledged.
The Commission's report highlights and echoes the Government's view only too well. Doctors, hospitals, and primary-care trusts on one side, patients on the other. In the middle a chasm of mistrust, anger, and frustration. A previously paternalistic medical system has been rightly changed into a patient-centred NHS. But does this mean that patients as consumers should lead, and that doctors and health-care systems should merely follow?
Patients have a wealth of information at their fingertips through the internet. What most do not have, however, is the skill and knowledge to sift useful and valid information and evidence from useless or harmful advice. In a mutually beneficial and effective patient-doctor partnership, medical expertise and knowledge need to be an accepted and valued part of that interaction, just as much as doctors need to have the time and skills to communicate preventive measures and treatment choices to patients appropriately.
Patients do not need to complain more. Instead, doctors and patients need to listen to one another more. Naked consumerism will not lead to better health.
Pois é!