Abstract
We have studied extensively the science of the doctor–patient relationship. The term ‘patient–patient relationship’ almost seems alien. Indeed, a google search defaults to doctor–patient outcomes. Yet patients interact far more with other patients than they do with their doctor. Is this a missed opportunity? A resource unrecognised? Patients are not confined to a 10-minute encounter with each other, and, as such this interaction is arguably a more powerful force. Why do we fear referring patients to other patients?
I chaired a patient participation group meeting where one patient expressed her inspiration from a patient support group that facilitated the stopping of all her painkillers. There is little emphasis on the science of the patient–patient interaction. The video consultation as an educational tool appears to be confined to the doctor–patient encounter. Should we support patients to engage not only in patient support but also in communication skills training so that they and their counterparts can benefit more effectively from each other? Giving and receiving feedback is a skill, but why confine education on this to doctors?
If the expert patient is an untapped resource, how can we use them more effectively? What training could we provide? Kennedy et al. (2007) undertook a randomised controlled trial to measure the impact of an expert patients’ program. Expert patients had a moderately higher rate of self-efficacy (one's belief in one's ability to succeed) and a small increase in energy levels. They also had a lower rate of hospital overnight stays although there was no impact on GP consultation rate. Could we use this evidence to support more expert patient involvement in supporting other patients’ care? We have researched the expert patient, but what about patients consulting with patients? The inability to prescribe, in my view, will be more than compensated for by the ability to empathise. Empathy and lifestyle interventions don’t need a doctor. Could others do it better? The doctor–patient relationship is complicated by hierarchy, the need to complete templates and the onus to prescribe. A patient–patient relationship would have more equal power status, more time and less constraints with arguably more patient focus. Expert patients could be trained in coaching style conversations. Consultations could take place in cafes or parks or while enjoying a walk. A ‘softer’ communication style would allow the patient to be more free thinking and feel under considerably less pressure than a stuffy consultation room with a doctor and a computer.
As a quality improvement coach we are taught to approach new ideas with ‘fresh eyes’ and sometimes consider reversal of the norm (e.g. patient treats doctor; though I am certain this happens more than one thinks). RD Laing (1927–89) was a free-thinking psychiatrist who took a very unusual, yet liberating, view of mental health that defied the conventions of his colleagues and was original and revolutionary. His inspiration was coined in the film ‘Mad to be normal’. You can see his inspiring talks on Youtube.
Louis Landman analysed the concept of the patient–patient relationship as early as 1955 in the context of group therapy. He reflected on the emotions and interactions between patients, negative as well as positive (Landman, 1955). This raises concern about the element of risk in using other patients as a therapeutic tool. Louis describes emotions ranging from competitive, vindictive and destructive, to passive and friendly with a sense of agreement and support, sometimes appeasing others for protection, help and admiration. But is this any different from the doctor–patient relationship, which can be tortuous and sometimes turn sour?
Social prescribing, where patients are encouraged to engage in community activity for support and enlightenment, is now well-established. But the concept of referring a patient to see another patient who has survived a challenge similar to their own is not yet commonplace. So, what can you do to explore the use of patient power in your workplace? A revolution may be at hand but an aspiring, effective leader is required. Could it be you?