Consultant physicians working with patients - Royal College of ...
Consultant physicians working with patients - Royal College of ...
Consultant physicians working with patients - Royal College of ...
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1 Physicians in the NHS todayrelationships between specialists and GPs, will probablyrequire more and not fewer specialists coupled <strong>with</strong> newcontractual arrangements.There is also an increased need to be aware <strong>of</strong> the health<strong>of</strong> a local population and the incidence and prevalence<strong>of</strong> particular diseases to best plan patient pathwaysinvolving primary care and specialist care, as well aspublic health medicine.Changing delivery <strong>of</strong> medical careThe delivery <strong>of</strong> acute medical care has graduallychanged. The new specialty <strong>of</strong> acute medicine isproviding more <strong>of</strong> this service. The traditional role <strong>of</strong>the consultant general physician in acute medicine hasreduced in recent years. However, the rising number <strong>of</strong>medical admissions and the increasing number <strong>of</strong> frailolder people <strong>with</strong> a number <strong>of</strong> different conditionsmeans that we have to think seriously about the bestway to care for the acutely ill medical patient and thebest balance between specialists and general <strong>physicians</strong><strong>with</strong> an interest in a specialty.There is also a need for more specialist centres to givehighly specialised care to a population, eg thrombolysisin stroke, because every hospital dealing <strong>with</strong> acutemedical admissions may not give this treatment. Astechnology advances, there are merits in groupingexpertise together in specialised centres that cover abigger population than a local hospital. Thesedevelopments may drive the need for reconfiguration<strong>of</strong> hospitals.Working <strong>with</strong> <strong>patients</strong>Patients, relatives and carers are knowledgeable. Theyask questions, and expect and require answers. Theywant to be more involved in making decisions about thepattern <strong>of</strong> their care. Many now communicate <strong>with</strong>their doctors by text and email, asking questions derivedfrom internet searches. The doctor–patient relationshipis evolving towards a more open, honest and equalpartnership from which we all benefit. Physiciansincreasingly involve <strong>patients</strong> and their carers instrategic plans and developments as well as decisionsabout their individual treatment and care. There isincreased emphasis on shared decision-making between<strong>patients</strong> and their health pr<strong>of</strong>essional – the RCP istaking this work forward in partnership <strong>with</strong> others,including patient groups and the departments<strong>of</strong> health.The RCP has appointed a clinical fellow in SharedDecision Making and supportive self-management totake this agenda forward.Many <strong>physicians</strong> also work <strong>with</strong> patient groups toinform the development <strong>of</strong> services and there is muchevidence <strong>of</strong> that in the specialty sections <strong>of</strong> Chapter 2.As revalidation becomes a reality, individual patientfeedback to clinicians will become routine. The nextstep, where this does not already happen, will be to gainunderstanding and feedback from <strong>patients</strong> and carersabout the totality <strong>of</strong> the clinical service and to use thisinformation to guide further developments.There is a need for future work on how best to work<strong>with</strong> <strong>patients</strong> and the public, to involve them as truepartners in service development and to learn from theirperspectives to improve clinical care and services.The RCP has a well-established Patient InvolvementUnit. The role <strong>of</strong> this unit is to encourage and promotepatient, carer and public involvement in RCP activities,and to ensure that all plans and decisions made <strong>with</strong>inthe RCP have been considered in collaboration <strong>with</strong><strong>patients</strong>, carers and the public before implementation.In addition to employed staff the unit has a lay patientandcarerchairaswellasanRCP<strong>of</strong>ficer.Over60<strong>patients</strong> and carers are members <strong>of</strong> the Patient andCarer Network. Network members are recruitedthrough open advertisement in a variety <strong>of</strong> media,including the Big Issue. They complete an applicationand interview, and references are taken up beforeconfirmation <strong>of</strong> appointment for a 3-year tenure, <strong>with</strong>the option to extend by a further year.The lay chair is responsible for chairing the Patient andCarer Steering Group where the strategic aims <strong>of</strong> theunit are discussed and developed. The lay chair is also afull member <strong>of</strong> Council.The RCP has worked hard to ensure that patient andcarer involvement is integrated into all areas <strong>of</strong> itsbusiness. Every specialty medical committee/board hastwo patient/carer members. This involvement has beena key tool in ensuring that the RCP has considered andacted upon first-hand patient expertise and experience.All patient care pathways and chapters <strong>of</strong> this book havebeen considered and contributed to by the members <strong>of</strong>C○ <strong>Royal</strong> <strong>College</strong> <strong>of</strong> Physicians 2013 11