15061 - Globalisation of the empowered health care consumer...

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Globalisation of the empowered health care consumer Richard Smith Editor, BMJ
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What I want to talk about Sick people: the global picture Global stories Who has the most “responsive” health care systems? Drivers of a changing world From industrial age to information age health care Patient partnership Doctors and patients: a new contract
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Global stories My father having a tonsillectomy in the 1930s: “Don’t do that, you dirty boy.” Colleague with severe psoriasis as a child; tied to the bed in the 1950s Asked to see a boy rendered paraplegic in a car crash in Sumatra in 1979: had severe pressure sore; no help possible Ward round with a surgical friend in India in 1998: “I can’t operate for two days as I’m going to Sri Lanka. Tell him we need to do some more tests.”
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Responsiveness of health care systems WHO studies
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Components of responsiveness Dignity: being treated as a person not a patient Autonomy: being able to chose for yourself Confidentiality Prompt attention: speedy access to care Quality of basic amenities: cleanliness, etc Choice of care provider Access to social care supports
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Several questions asked on each component: autonomy How often are patients provided with information on alternative treatment options? How often are patients consulted about their preferences on different treatment options? How often is patient consent sought before testing or starting treatment? Never/Sometimes/Usually/Always
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Position and score on responsiveness 1 United States 8.10 2 Switzerland 7.44 5 Germany 7.10 16 France 6.82 20 Singapore 6.70 26 United Kingdom 6.51 108 India 5.02 191 Somalia 3.69
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Those who experience low responsiveness Old Women Ethnic minorities Indigenous populations
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The most “disempowered” consumers Prisoners Substance abusers Sex workers Learning disabled Asylum seekers Homeless Travellers
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From industrial age to information age health care Remembering that many still have preindustrial health care
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Drivers of change Rise of the resourceful patient Information technology, particularly the internet Growing gap between what could be done and what can be afforded “In Scotland where I was born death was viewed as imminent. In Canada where I trained it was seen as inevitable. In California, where I live now, it’s considered optional.” Ian Morrison Science, particularly genetics Big ugly buyers Increasing medicalisation Globalisation Rise of ethical issues--autonomy to the fore
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Towards patient partnership
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relationship 1871 Your patient has no more right to all the truth you know than he has to all the medicines in your saddlebags. ..He should get only just so much as is good for him. Oliver Wendell Holmes
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15061 - Globalisation of the empowered health care consumer...

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