I am currently reading Angela Coulter's book 'Engaging patients in healthcare'. It offers practical advice to patients and clinicians alike so that they can 'co-produce' good health outcomes. Co-production is a buzzword in public policy at the moment. It implies a greater degree of participation in the design and implementation of services by members of the public. The wider concepts of 'Public Value' and 'Social Value' take up this notion to improve the impact of a given service.
In the case of healthcare, co-production requires patients to take more initiative to address their health needs, and it encourages clinicians to work more sensitively and creatively with patients in order to nurture this initiative. Whether it is in the design of a course of treatment that takes into account personal preferences and circumstances, or in the adaptation of lifestyle for preventative purposes, co-production promises a higher degree of patient motivation and thus anticipates better health.
In so doing, co-production challenges the philosophy of 'the professional'. Clinicians, particularly physicians, have strong professional values and mindsets. The professional is a highly trained individual set within the context of a community of practice and subject to modes of acceptable behaviour and standards. He or she draws from a breadth of knowledge and experience to guide a person through the complexities of their situation. Physicians have traditionally required patients to accept their direction and to adhere to proposed treatments. Co-production shifts the nature of this interaction so that the physician is in a more responsive role. The autonomous patient requires the advice of the physician in order to decide upon a course of action.
It would be inaccurate to portray this as an either/or situation. The doctor/patient relationship has always been complex, with power ebbing and flowing between. But this is a real tension that needs careful thought. In an era of increasing standards of education and more immediate forms of information supply, the patient is becoming far more knowledgable and demanding. It is not enough now to assume the dull obedience of the patient to the superior wisdom of the physician.
This all reminds me of changes that have been going on in the church over past years. People have formed their own views about theology and religious practice. They have in some cases set up their own independent churches to nurture their own faith experience. The professional recognition of clergy was challenged half a millennium ago and is now far from authoritative. In matters of faith, people are largely autonomous and self-supporting. This is a long way from the situation with clinicians, but the signs are there that people wish to exercise more choice and autonomy than they once did.
Angela Coulter has provided some helpful pointers to do this well. I commend the book to all.