Would it not be better to have a greater number of “quite expert by dfhercbml

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      Would it not be better to have a greater
       number of “quite expert” patients?
                                                                   By Peter Jenkins



     T
              he concept of the expert patient is     ed, the signs appear to be promising — but               Then there is the postcode factor.
              intriguing and seductive. It would      what criteria are being used?                       Those patients in the more salubrious, well-
              seem to solve several problems of           What could be called the “level of              populated areas stand the best chance of get-
     the cash conscious but determinedly for-         expertise” of a patient is what will determine      ting help from patient organisations.
     ward looking National Health Service by          the usefulness or otherwise of this project         However, this help is limited and although
     energising a whole new phalanx of people to      and its benefit in defining the best use of         the organisations do their best the results
     back up the work of full-time professionals.     resources over time.                                are, in the main, disappointing.
     Its development, by researchers looking for          At present the plan is to empower a                  Rather than working towards so called
     new streams of health care and finding an        cohort of patients with a high degree of            “expert patients”, who, by definition will
     original use for personnel who do not need       expertise. The result will be a relatively          be limited in numbers, it may be better to
     to undertake long and expensive degree           small      number        of                                              go for a greater
     courses, has certainly been well sold to         patients      throughout                                                 number of “informed”
     politicians grappling with the present and       England, trained and                     I am not                        or      “quite     expert”
     perceived future needs of an increasingly        serviced by a series of                                                  patients instead.
     elderly population.                              professionals who have                  suggesting                             The political argu-
          However there could be unfortunate          had to devote a consid-                                                  ment against this is that
     results. In these circumstances there is         erable amount of time              abandonment . . .                     it is not nearly as sexy to
     often a determination to see a project           to this work. Even                                                       work towards or write
     through, despite its weaknesses, because         when the scheme is                but rather involving                   about if there are no
     failure to do so would lead to an unaccept-      established, ie, user-led,                                               “trophy patients” to fea-
     able loss of face for the protagonists of the    and can be said to be              a greater number                      ture. Despite this the
     scheme. This scenario has already been           self developing, the                                                     greater good for the
     played out many times when political expe-       input of professionals               of patients at a                    greater number is the
     diency and the ability to “find” resources       cannot be discounted                                                     most important health
     come together.                                   nor can the work lead-             not-so-complicated                    gain.
          A good example of this is NHS Direct.       ing to that stage be for-                                                      In reality even the
     In theory an alternative source of informa-      gotten. All this means                     level                         expert      patient      as
     tion and help available 24 hours a day from      that a great deal of                                                     defined in the litera-
     the comfort of your armchair. It is certainly    resources, both man-                                                     ture is a limited con-
     being used and the advice stream cannot be       power and materials, has been expended on           cept. He or she is not medically trained to
     criticised given the conditions in which it is   a relatively small number of patients.              evaluate new symptoms, perhaps from a
     made available. However, although the fig-           Within the recommendations of the               new complaint, and his or her interests will
     ures for uptake are impressive, not so           task force is the call for a partnership with       be subjective. Only the unusual sick person
     impressive is the fall in                                              patients’ organisations       can truly step outside their condition of
     numbers seeking other                                                  and voluntary groups.         pain, immobility, breathlessness or med-
     consultations. The oth-              There is often                    One wonders at what           ical gadgetry.
     er cost which is not con-                                              level this can be imple-           Other countries use the term “self-
     sidered is the number of          a determination                      mented in practice. It        management”. Perhaps this better describes
     experienced nurses now                                                 will    inevitably     be     what should be aimed for in order to
     practising triage on                to see a project                   patchy, disappointingly       achieve the best results for the effort
     computer-based path-                                                   so for a scheme where         involved.
     ways in an office rather          through, despite                     the hope is that patients          I am not suggesting abandonment of
     than using their exper-                                                are to be empowered by        this innovative and empowering scheme
     tise, gained over many              its weaknesses,                    various         agencies.     but rather involving a greater number of
     years of training, deal-                                               Despite the encourag-         patients at a not-so-complicated level. I am
     ing with patients face to         because failure to                   ing reports and news          also suggesting a greater use of self-help
     face. How much this                                                    items over the years          groups and charities, and those health pro-
     expensively       trained          do so would lead                    about the work of char-       fessionals who see and communicate with
     group is contributing to                                               ities and support organ-      patients on a day-to-day basis. Community
     the     much-trumpeted           to an unacceptable                    isations for patients,        pharmacists should be more deeply
     figures for nurse short-                                               when it comes to sup-         involved in the scheme in order to get the
     ages on the wards and                  loss of face                    plying a base the patient     message across to as large a number of
     out in the community                                                   can build on the reality      patients as possible. Not all of these
     we will never know. But                                                is generally less com-        patients will end up as experts but it will
     the project must be maintained and               forting. This is due to several weaknesses,         boost the average sufferer who needs some
     applauded because the opposite is unthink-       including a lack of funding and committed           extra help, for whatever reason. The net-
     able given the amount of political capital       personnel, and an obligation to work office         work of community pharmacists is already
     invested in it.                                  style hours resulting in no or minimal cover        in place as are the postgraduate centres to
          The pilot stage of the Expert Patient       over weekends and national holidays. Ill-           give them any additional training they may
     Programme will last until 2004 and there         ness does not recognise these boundaries.           need.
     are many primary care trusts that have                                                                    I believe that with these reservations
     already run courses as part of this pilot pro-                                                       the project would have greater potential —
     gramme (PJ, 31 May, p743). So far,                 Peter Jenkins is a retired community pharmacist   but perhaps it would not hit so many head-
     although full evaluation has only just start-                                                        lines.

80                                                    THE PHARMACEUTICAL JOURNAL (VOL 271)                                                   19 July 2003

								
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