2.8 Partnerships” – Communicating with “Partners”

The medical approach to health promotion  encourages dependency on medical knowledge and removes health decisions from the people concerned.  Health care workers are encouraged to persuade patients to co-operate and comply with treatment. According to Naidoo and Wills (1994), the medical approach reinforces not just the medicalisation but also the medical hierarchy, with doctors over other health care workers.

Coulter, Entwistle and Gilbert (1998) promote the encouragement of patient participation which they state stems from a belief in the ethical principle of autonomy. “Health policy makers are beginning to recognise that patient empowerment could have an important part to play in the service provided.”
Regardless of the genuine intention to help and empower people, the reality of the participatory processes is often contradictory to the empowering principle.

Coulter et al (1998) describe relationships between professionals and patients in the NHS as paternalistic in nature, encouraging dependence on health professionals and fostering demand, sometimes inappropriately.

 It has long been recognised that there is a positive relationship between communication and clinical outcomes (Ley, 1988). In 1991, an international conference on doctor-patient communication published a consensus statement.  Among the main points were: patient dissatisfaction is related to uncertainty and lack of information from the doctor; (Simpson, Buckman, Stewart, Maguire, Lipkin, Novak and Till, 1991).

Fundamental to the concept of empowering people is that they are making informed decisions when they consent to any form of medical intervention.  Consent is the process by which a fully informed patient can participate in choices about their health care.  It originates from the legal and ethical right the patient has to direct what happens to their body and from the ethical duty of the physician to involve the patient in their health care (Coulter et al, 1998).

WHO (2003) recommends advocacy on the commitment to achieve global routine immunisation is needed to empower people. It argues that unless there is political will at the global leadership level there is limited opportunity to reverse the decline of routine immunisation. Opportunities should be sought to improve uptake and it would appear that the ends justify the means.

Many studies have been done suggesting ways to improve vaccination uptake. Influenza is a major cause of morbidity and mortality among residents in nursing homes. According to a Dutch study by Verweij and Van den Hove (2000), many nursing homes in the Netherlands aim to have a high vaccination uptake against flu.  To meet this aim some nursing homes use tacit consent policies in which a vaccine is given unless residents or their proxies state that they do not want it, this policy results in higher vaccination uptake.

 Such policies deviate from standard consent procedures, which require that vaccination occurs only if the resident gives consent.  Similarly, millions of babies are vaccinated every year and the quality of consent given by parents is not clear.
The Patients Charter (Department of Health, 1992) promised patients the right to information about their health care and the opportunity to be involved in decisions about their treatment if they so wished (Coulter et al, 1998). 

The NHS Executive’s Patient Partnership strategy was launched in 1996 with the aim in clinical practice of enabling patients to become informed about their treatment and care to help them to make informed decisions and choices about it if they wished. The Department of Health (2004) states “in order to make a decision you and your parents need the doctor or nurse to give you information about the treatment which they are offering”, and encourages parents to ask questions to aid any medical decision making.

These were not the findings of a study by the King’s Fund on Informing Patients, which found that most patients did not receive the information they would like, and when they did get it the quality of information materials was poor.  “Many materials contain inaccurate and out of date information and few provide information on treatment risks and side effects”.   Medical terminology was not explained and where the doctor was unsure of the answer it was glossed over.  Information about treatment effectiveness was often not included or unreliable. The report concluded that few patient education materials in GPs’ surgeries actively promoted shared decision- making (Coulter et al, 1998).

Unreliable information poses a major problem due to the enormous variety of health care professionals and lay people involved in the implementation of immunisation programmes (doctors, health visitors, practice nurses, school nurses, pharmacists, health promotion staff, politicians and public relation experts). It is therfore necessary to have a mechanism for ensuring that all these elements work together to provide an efficient service (Bedford and Elliman, 2000).