NHS Patient Activation program is set to use 14 Questions to profile Patients into 4 groups

Dr Phil Hammond BBC Radio Bristol

DrP: Tell us about Patient activation and what it all means?

What it all means is having an understanding of where Patients are in terms of their knowledge skills and confidence to manage their own health for themselves. And then kind of matching what you do as a clinician and what you say to support them to help them develop a higher level of knowledge skills and confidence because that actually leads to better outcomes.

DrP: We can sort of understand that there are some Patients that there are some that like the Doctor to take control and want to treat the Doctor as an expert and some people who want to be treated as equals and share decisions there might be some who actually want to take control and say these are my goals and outcomes. How easy is it for a busy Doctor or Nurse in the heat of about 10 minutes to figure out at what level a Patient is or does the Patient need to think about it before they go into the consultation?

“I think that what you said at the end there is actually the most important thing in supporting people to figure out before they come into see the Doctor where they actually are. If you don’t do that there are some really simple things that you can do as a Doctor. Just saying to people “so tell me what you’re already doing to manage things for yourself?” and that gives you a really good clue as to where people actually are.

“I remember when I was teaching communication skills to students in Birmingham we had this wonderful thing called the Cobill computer which analysed different consultations and the things Doctors said to Patients and I’ve recorded loads of my own conversations and I found rather distressingly, thinking I was a gifted communicator, that my little chat for back pain was pretty identical regardless of the Patients background or level of understanding. it was almost like a needle dropping on a record. I would go all “…oh back pain, ba, dumpa dumpa dump” in and out the door in ten minutes. So what you’re saying is we need to invest a bit of time listening to the Patient, discovering their level of understanding and then discovering how much they want to do for themselves and how much we need to do for them?”

“Exactly and that kind of fits with all kinds of everything we know about education theory doesn’t’ it really? If you’re going to teach somebody you figure out where they are to start and then match your teaching style accordingly”

Dr Phil Hammond talks with Somerset based Pain Management Dr Alf Collins and Luke O’Shea, Head of Patient Participation, NHS England (from 91 min)

My thoughts:

Could you imagine what a Doctor who is as honest, decent, sensitive and aware of the actual challenges of our modern healthcare system as Dr Phil could achieve for Patients and Carers if placed in a leadership position in the NHS?

This morning I tweeted a link to this post suggesting the program gets fellow NHS GP Dr Amir Hannan on the show to discuss his Surgery Cares program that enables Patients to access more comprehensive interactive patient history taking questionnaires.

I think it’s clear we’re at a stage were we should be doing more than just looking for an additional “really good clue as to where people actually are” by asking them to answer a fixed series of 14 questions. We should also be effectively documenting this so that a record is made that can move with the Patient through the NHS. The stark reality is we don’t need to “invest a bit of time listening” so that we broad brush pigeon hole Patients on a scale of one to four. We need to invest resources in scalable evidence based tools that can learn from feedback so that it’s eventually possible for Patients to share all of their important information before meeting with a Doctor and do this every time they access a Doctors care (surely it’s obvious that a Patient might want to be in full control of the management of their hay fever but want to cede complete control to the experts for something else like their failing eyesight).

Adding more questions for Doctors to ask in the appointments is in my opinion simply failing to realise that there is a shortage of 10,000 GPs in the UK and the time of the GPs the NHS has is the thing that’s being stretched in every direction and the big opportunity today to improve outcomes is not in focusing on the few minutes within the consultation but in utilising the thousands of hours Patients are spending outside the consultation room in which they could contribute.

In a world where Patients campaign to get 36 seconds before being interrupted I wonder how Patients will respond to being asked “so tell me what you’re already doing to manage things for yourself?“.

It sounds to me like the classic MBA speak that hasn’t really considered the many nuances of the Doctor/Patient relationship. I can imagine it will be met by Patients with statements like: “Can we just focus on why I’ve come to see you today as I’ve waited a week for this appointment, have missed a morning of work already and have probably got only 8 minutes of your time so let’s not waste a single moment of it because I came here to specifically talk with you about my health problems“.

I must be missing something as the idea of asking 14 questions to profile a Patient into one of only 4 groups seems nonsensical (why not just ask a Patient which of the four groups they feel they resonate most with and then ask 13 much more useful questions?) but I can’t wait to see what they are as if they’re useful I’ll make sure they’re covered by the Instant Medical History adaptation we use here at 3G Doctor.

Dalai Lama if you listen you may learn something new

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