The hard task of doing what matters for patients

Patient centredness has a clear focus. Ask a patient, ‘What matters to you?’ It might be that you can meet your patient’s expectations. Alternatively, you may need to do something differently or better. To achieve that change, you will need to call on what you have already learnt or learn something new. Placing your patient’s needs at the centre of your clinical practice in this way is hard, especially with the rising demand for healthcare and constraints on resources. But patient centredness is an essential value of healthcare, and it isn’t going away. Here, doing the hard thing is also the right thing.

One step beyond is the even harder challenge, and perhaps even greater imperative, of speaking up on matters of patient safety. In an ideal medical culture, raising issues of concern about patient care should be without fear or inhibition, the everyday duty of any conscientious practitioner. But medical culture is not ideal and instills fear and inhibition. Doctors do not feel comfortable raising issues of patient safety, as this month’s research paper demonstrates. ¹

The study by Antonia Rich et al. shows the value of qualitative research, helping us understand the reasons for this system failure. The authors apply the theory of planned behaviour, a widely used psychological model, in a group of doctors that spans grade, specialty and geography. Among the themes that emerge are that doctors encounter disapproval for raising a concern at all levels. Their concerns are sidelined. They fear professional isolation, are influenced by the negative treatment of whistleblowers in their institutions and the media and feel disempowered to raise concerns about people in positions of greater power. These findings are food for thought and a call to action for policy makers who find it easy to talk the language of patient centredness and patient safety but find it hard to enable it by creating a supportive culture.

On other pages, Hajira Dambha-Miller and colleagues discuss how healthcare can embrace empathy and compassion. ² John Ashton documents the failure of public health. ³ Greg Maguire urges us to consider the risks along with the rewards of stem cell therapy. ⁴ And John Axford takes on the hard task of explaining progress in translational glycobiology. ⁵ Nothing that matters, as we know, comes easily.