a systematic review of 20 evaluations of interventions designed to increase patients’
participation in medical consultations Harrington, Noble and Newman (2004) found
that half of the interventions resulted in increased patient participation with greater
effects being observed for clarification-seeking rather than question asking. They also
noted a variety of other positive outcomes including perceptions of control over health,
preferences for an active role in health care, greater recall of information, better
adherence and improved clinical outcomes. Harrington and colleagues suggest that
question asking may not be the best measure of whether consultation empowerment
interventions are effective. They note, for example, that patients’ perceptions of control
over their health and preferences for an active role in their health care were found in
all four studies that considered these outcomes. Given the importance of encouraging
the general population to take a more active role in preventive health care (Wanless,
2002) further work on such interventions is warranted.
One objection to interventions designed to empower patients during consultations
and to patient-centred consultations is that they are likely to be longer and doctors
are already hard pressed to see patients who want consultations. Howie et al.(1999)
examined nearly 26,000 randomly selected adult consultations across 53 medical
practices and observed consultation times ranging from less than 5 minutes to more
than 15 minutes with a mean of 8 minutes. These researchers administered a patient
enablement measure, which resembles a measure of consultation-generated, health-
related self-efficacy (see Chapter 7). It measured whether patients felt the consultation
had made them better or worse at understanding their illness, coping with their illness,
keeping themselves healthy and feeling able to help themselves. They found that patient
enablement was associated with longer consultations and knowing the doctor better.
They concluded that, ‘It may be time to reward doctors who have longer consultations,
provide greater continuity of care, and enable more patients’ (Howie et al., 1999: 738).
Longer consultations may not only be associated with greater patient enablement.
Reporting on a review of 14 studies Freeman et al.(2002) noted that longer consul -
tations were associated with less prescribing, better recognition and management of
psychosocial problems and better clinical care of long-term illnesses. Longer appoint -
ments may also be more likely to resolve problems and so reduce follow-up visits for
the same problem (Hughes, 1983). Thus a shift to somewhat longer appointments and
greater continuity of care (that is seeing the same doctor over time) could have
beneficial effects on the effectiveness of health services.
COMPLEMENTARY THERAPIES AND PLACEBO EFFECTS
Poor patient satisfaction and uncertainty about the effectiveness of traditional medicine
fosters demand for complementary or alternative medicine (CAM). Complementary
therapies include a wide range of interventions based on different models of mind and
body. The defining feature of such therapies is that they are not understood in terms
of the evidence-based models of physiological systems (see Chapter 1). Many also differ
from traditional medical care by focusing on the client’s overall well-being rather than
specific physical problems.
CAM use is widespread in developed countries. It has been estimated that 42 per
cent of the US population have used CAM spending more than $21 billion annually
RELATING TO PATIENTS 243