Blog > Patients everywhere want to be sure they have a good Doctor – and they have a right to!


Patients everywhere want to be sure they have a good Doctor – and they have a right to!

Sir Donald Irvine CBE MD FRCGP FMedSci, patron of Picker, discusses his illustrious career and specifically the continuous value of Individual Clinician Feedback (ICF) in the NHS, in strengthening the patient/doctor relationship.


What do you think it means to be a doctor in 2014?

I think that there is a massive difference between just being a Doctor and being a good Doctor. As is true of any profession there will be those who take their jobs seriously and strive to deliver the very best work at all times, and there will be those who clock-in and clock-out, delivering minimum output with the minimum of effort. The same is true of doctors, only in this instance it’s not just salaries that are being gambled with, but patient lives. Something far too precious to be taken so glibly.

I think the principles of being a good doctor are the same in 2014 as they were previously, good doctors put their patients’ care first and consistently work to improve on the service they deliver to them.

To me not only the definition of a good doctor, but a great doctor would be William Osler, who epitomized professionalism at its finest. In his textbook of medicine, his up-to-date knowledge was there for all to see. He obsessed about the need for early diagnosis, had a huge respect for patients and colleagues alike and had a strong sense of the rights and wrongs of professional conduct – an inspiring bedside teacher. Osler knew all about variations in professional practice, which in his day ranged from the excellent to the execrable and always strived for excellence.

Were he here now, he might well wonder why such a successful profession, which in the last half century has helped so many patients in ways that he could scarcely have dreamed of, could still find itself unable to insist on a decent standard of practice from all its members, not just the conscientious majority.


How do today’s principles differ from Osler’s prescription of quality care?

In 2014 it is not the principles of being a good doctor that have changed but the working culture of doctors in general, that has fallen out of sync with social transparency and patient expectations.

My wife and I have seen this first-hand. Nearing eighty, we both have long-term conditions and so see more than we would wish of the NHS in action. Though we have an excellent family doctor, in our encounters with extended NHS services we have unfortunately seen it all – the good, the bad and, in between, the many shades of grey mediocrity in patient care.

The factor distinguishing these shades of care comes down mainly – in my opinion, to the attitude and ability of individual clinicians. The difference between a doctor who gives exceptional care, and the doctor who basically just turns up and ticks boxes.


Where do you think this inconsistency has come from?

For a long time the dominating care option has been one of a negative doctor-centred culture. The NHS too often expects patients to be the unquestioning, grateful recipients of state funded care rather than vocal users who have in reality paid their taxes to help fund the Service and who have a right to decide for themselves which providers and choices of treatment are best for them.

Common sense and hindsight has shown that the best possible results come from a patient-centred culture, where patients have the right to expect the best possible care at all times.


Can you elaborate on this cultural shift?

Since I started practising in 1958, right through to my presidency at the GMC, I have had a ringside seat, and considerable personal involvement, as the process of cultural transition has unfolded in Britain. The experience has taught me just how difficult it is for the profession to change from a traditional doctor–centred culture to a patient-centred culture, in tune with public expectations now.

For the transition to complete and work well all individual doctors have to follow the same code of conduct and consider what it is patients actually want from them. For me, Osler’s best practice prescriptions are is relevant now as they ever were. Being a doctor is not simply about working hard to qualify and then making your own rules, standards have to be maintained, and where they fluctuate, improved.


How would you describe current patient expectations?

Like the principles of being a good doctor, the principles of patient care have not changed with time. Patients have just become more vocal and have more platforms available to them to express them.

Unlike doctors, patients do not and have never talked about professionalism as an entity. Instead, they see being professional as consistently good doctoring.

For them ‘good doctors’ are up-to-date, competent, respectful, courteous, kind, empathetic and honest; people who will listen to them, relate to them, do their best to find out promptly what is wrong with them, prescribe the right treatment and care for them in a manner which makes them feel that their interests come first.  Patients want their doctors to be good team players when teamwork is needed. All these qualities are essential elements of a trusting doctor-patient relationship.

Trust is imperative.


You mentioned there being more communication platforms for patients than ever before, what are the key ones in your opinion?

With time comes change, and over the course of time the world we live in has simply changed, this has naturally effected the way patients gain information.

There are more healthcare regulations in place to protect patients now and more sources of information both in terms of organisations and general outlets. The internet is heavily imbedded in everyday life, and for most people social media is as normal as receiving a letter – possibly even more so. Social media is an instant and effective communication exchange that is gradually helping patients to take control of their healthcare experience.

When you think about it they now have access to more information than ever about the results of care given by individual clinical teams and clinicians. For example, today anyone can access the knowledge base of medicine directly without mediation by a doctor – just at the click of a button they have access to total transparency about their doctors’ performance and track record.

There is more power in patients’ hands than ever before and because of that they have more choices available about the kind of care they choose.

There is more power in patients’ hands than ever before and because of that they have more choices available about the kind of care they choose.


How do you think Picker and the work conducted by the organisation, has impacted patient expectations?

I think Picker and the like has played a massive role in the transition of patient experience, and the doctor/patient power exchange. Thanks to our late, great founding father Harvey Picker, the tools and research now exists to give the public immediate and accurate information about other people’s healthcare experiences – right down to individual doctors, nurses and health care providers. Not only that but they can see clearly whether that experience met professional standards, and whether they are getting “good” care or not. Knowledge is power, and all these developments are and will continue transform the relationship between patients and doctors in the future.

Patients are simply much more knowledgeable about their own care now, and rather than regard these developments as a threat, doctors should see them as an opportunity. An opportunity to rethink and rebuild the benchmarks of patient trust, so that they can improve patients’ healthcare experience in general.


How can doctors regain patient trust?

All patients really want is to be able to trust their doctor without having to think about it. But for that to happen, the basis for such trust must be absolutely sound.

They want to know that their doctors’ are practising to a standard that is ‘as good as it gets’. Naturally they expect continuous improvement as medical science advances, but for them generic improvement is not the same as, or a substitute for, a guarantee of their doctor’s overall professionalism at the time of a consultation. They want to know the person treating them is “as good as it gets.”

That’s where the doctor/patient obligation comes in. Patients can now spot doctors who are not “as good as it gets” very quickly, and they not only try to avoid them if they can but to expose them.

As we know from the Harold Shipman murder case, when his gross misconduct and patient neglect became national common knowledge, doctors no longer have that level of invincibility, so why has the culture remained do you think?

When you think about it, in any role, an employee receives an annual appraisal, where their current performance is measured against previous years, and any changes- good or bad, are noted and an action taken. It’s hard to imagine but before the establishment of the GMP, doctors did not have appraisals.

As president of the GMC I saw first-hand how the foundation of the Good Medical Practice (GMP) in 1995 and the subsequent Care Quality Commission (CQC) have started to improve things in terms of policy and regulation.

Donald discusses his recommendations for improvement:

Through your eyes, what would real change look like?

Professional regulation is only the underpinning step. It is the doctors themselves who have to change, they have to consciously commit to giving the best possible care, by meeting and exceeding best practice standards. That will ultimately decide the degree of trust patients and the public invest in doctors in future.

How can a supposed threat but turned into an opportunity for progressive change?

The change needed to realign the medical culture of professionalism with today’s public expectations is already under way. Future generations of patients and doctors may likely wonder why the transition was so difficult and took so long. After all, they may say, wasn’t it obvious?

But I’m not unsympathetic to the extenuating circumstances. Today, every country is wrestling with the ever-increasing complexities, costs and risks involved in running a modern health care service. Offering good quality care, on the lowest budget, has become essential, and it is not an easy task. But when individual doctors themselves decide to change their professional culture in spite of these prevailing forces, real progressive change will happen. And patients’ care needs will be not only met but exceeded.

Patients everywhere want to be sure that they have a good doctor, and they have a right to. It’s time to get back to basics, remember why we became doctors in the first place – to provide quality care to people, and revisit the essentials.

Donald Irvine’s essential principles of quality, patient-centred care:

  1. Prime focus on the needs of the patient, as seen through patients’ eyes.
  2. A holistic culture of professionalism embracing medical practice, medical education and medical regulation.
  3. Inspired medical leadership willing to challenge the orthodoxy of the status quo.
  4. Optimal standards – the best we can do today – to become the norm.
  5. Specialist colleges and societies to take full responsibility for setting and monitoring optimal clinical standards in their respective fields.
  6. The absolute necessity for high quality data capable of showing regularly whether clinical and care standards are being met.
  7. Linking aspiration, the pursuit of excellence and personal responsibility through continuous professional development.
  8. Every clinician to have regular, expert, evidence-based, formative and summative appraisal against generic professional and specialty-specific standards.
  9. Evidence demonstrating individual doctor performance to be published regularly by professional societies, employers and regulators.
  10. Use of the power of role modelling to the full in transmitting professional values and standards to the young by example, through practice and education.

Tags: Individual Clinician Feedback.

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