Friday, 8 June 2012

Let's Hear it for Listening

Yesterday the Department of Health announced a new rating for GP surgeries – marks out of 10 for ‘patient experience’. The rating is designed to enable people to make comparisons between surgeries when deciding which surgery to register with. A score of 10 is high and it is based on information given in the patient’s survey, a questionnaire given to a random selection of people visiting their GP after their consultation. You can see the ratings on the NHS Choices website.

A key new factor included in the rating is ‘whether doctors and nurses are good at explaining things and listening to people’ – part of the job description of a health professional, you might think, and certainly this factor is welcomed by the Patient’s Association who say they hear increasingly from people who are not listened to effectively. However, this seemingly straightforward aspect of a consultation being rated has raised some strong feelings among healthcare staff. A comment from a practice manager in the health professional online magazine ‘Pulse’ yesterday was that maybe patients should be rated on their ability to listen as many problems arose because of people ‘failing to remember the basic information they have been told’. This comment drew a number of ‘well said’s from other contributors, among them a GP who felt that ‘It’s about time patients' responsibilities were highlighted as well as doctor’s’.

It sounds from all this, as though both patients and doctors feel frustrated – patients because they don’t get enough time to take in information properly, and doctors and other health professionals because their attempts to give the best care are hijacked by government pressure and targets, for example having to deal with a number of medical issues in only a 10 minute consultation. When stressed like this, it’s not surprising that both parties are tempted to blame the other.

But could there be another suspect entirely that is to blame for the mismatch between expectations and reality? namely the system in which care is delivered. For example, we have often heard from health professionals who have been given extended consultation time alongside undertaking a course, to help people manage their diabetes more effectively (‘Insulin for Life’: Chaplin, Widdowson and Reeve, 2012). They report that they found the benefits of conversing with people in a more relaxed way about their lives, challenges and hopes and dreams was incredibly useful, not to mention satisfying. Even more importantly, this approach improved outcomes for both patient and health professional.

This would seem to suggest that, in long term conditions at least, that systems need to change to accommodate the needs. In the above example, many GP surgeries also began dedicated clinics for diabetes as a result of their experiences, and have found it a really effective way of meeting the needs of people with diabetes. This suggests that there needs to be a practical and meaningful stimulus to make change happen.

By coincidence, an editorial in recent edition of Diabetic Medicine (Cradock and Cranston, 2012), addresses just this point. The authors suggest that much more ‘emotional mastery’ - support for people with diabetes to deal with the stress caused by taking care of their diabetes - is needed alongside ‘insulin mastery’ (dealing with the practical aspects). This suggestion is based on research showing that at least some diabetes-related stress may actually come from the diabetes consultation itself. This is because traditionally, the consultation places medically-based expectations on the person with diabetes, causing feelings of anxiety and guilt and thus contributing to raised HbA1c levels. Creating a system of care which places much less emphasis on insulin and much more on reducing the emotional effects of diabetes may well be an important factor in reducing HbA1c – the ‘holy grail’ of most current diabetes services.

Perhaps the findings of such a model could be shared with health services as a whole and adapted so that both health professionals and people using their services can feel less pressured, less blamed and become more healthy as a result? After all, as Einstein himself said: ‘doing the same experiment over and over, and expecting different outcomes… is the definition of insanity’. Perhaps given its benefits, healthcare professionals may not be so defensive about changing the experiment to include more listening?


Chaplin, S, Widdowson, J., Reeve, B. (2012). The Insulin for Life programme: nine years on. Practical Diabetes, 29, 2 (supplement)

Cradock, S., Cranston, I. (2012).  Type 1 diabetes education and care: time for a rethink? Diabetic Medicine, 29, 2, 159-160

Department of Health (2012). Government opens up data to benefit patients and GPs online