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Engaging Rather Than Only Treating and Caring

Third Revolution in Healthcare

Engaging Instead of Only Curing and Caring – Sharing the Liability for informed exchanges

Middlemarch (a novel by the English author Mary Anne Evans) chronicles a rural doctor’s ascension and begins to trace a parish priest’s downfall. In the 20th century the priest’s charismatic authority declined, but the doctor’s charismatic authority increased and was strengthened by what is known as his wisdom or, in the case of the Aesculapian medical profession, that is gained from knowledge. By establishing a central governing body and eliminating the requirement to pay for consultation or treatment, the authority of the physician and the passivity of the patient have been strengthened. Clearly it was very good not to prevent people from seeking care because of financial fears, but to ensure that the legal contract between the patient, the primary person, namely the person with the issue to be resolved and the agent, namely the person who was capable of solving the problem, is now broken.

However, there is a considerable change in relationships in the third health care revolution. The patient now has access to a wide range of best available knowledge. Although many research reports continue to be behind the pay wall, a growing proportion of systems are however being reviewed, including the rich vein of Cochrane reviews, which are now digitally available to everyone and which have shifted the power to a fairer position by means of rebalancing of knowledge. However, digital opportunities should not just be used for evidence but also for the planning and delivery of care by both people and groups.

I prefer to see engagement as a set of reciprocal tasks, as follows: ‘working together to promote and support active patient and public involvement in health and healthcare and to strengthen their influence on healthcare decisions, at both the individual and the collective level.”

“An engagement strategy should take account of the varying requirements of patients and citizens, adopting clearly specified objectives and monitoring progress carefully.  The maintenance of trust in the health system and between patients and clinicians will be important.”

Source:  Coulter, A. (2011) Engaging Patients in Healthcare. Open University Press. (p.10).

It is crucial to stress that people are accountable and entitled to develop what Etienne Wenger calls a practice community.

The work of engagement is basically the work of forming communities of practice.”

Source:  Wenger, E.  (1988) Communities of Practice: Learning, Meaning, and Identity. Cambridge University Press. (p.184).

The second healthcare revolution was followed by Patient Participation Groups and Foundation trust membership groups, but with digital tools such as Zoom, and podcasts new avenues of community building were introduced.

Connotations For Health Services – We Need To Engage Patients and Carers.

The relationship was pretty uncomplicated at the end of the 20th century. The patient came to the office, had symptoms, tested, and produced a diagnosis, sometimes ignoring what genuinely troubled a person, as we emphasized in the last episode. Healthcare ensures excellent quality and efficiency; it is nonetheless inadequate whilst necessary. The need to interact with patients and carers through the collection and use of digital knowledge gained through experience is one approach to achieve this goal, since healthcare is usually considered as the most complex business on Earth.