Study on the roles of expert patients

Expert patients are people who have in depth knowledge about their medical conditions. They play a pivotal role in the selection of medication management of chronic diseases and are able to manage their conditions leading to improved quality of life.(puk ref 1)

Evidence shows that expert patients tend to

Gain more confident regarding to their medical conditions and are less anxious about their management

Reduce doctor visits

Have a better rapport with other healthcare professional, e.g. nurses and pharmacist.

Reduce time off work as they are able to manage their condition.

Reduce hospital admission because of acute condition. (puk ref 2)

The main aim of developing this program is the enable the patients to

Manage their condition

Communicate effectively with healthcare professionals

Be more aware of the impact of their medical conditions on themselves and their family members

Use their skills and knowledge they gain through this program to lead a fuller and happier life.(puk ref 3)

The concept of expert patient is not something that has been introduced recently, but it has been in practice as management program for chronic conditions. With the widespread use of internet, patients are more aware of their well being and general awareness about healthy lifestyle.(abpi)

Expert patient could be the well informed patient who engages with the doctor and decides the best course of action. This relation can also be perceived as common ground on which the patient makes their decision after considering all the well informed options available to them. (abpi)

In recent years medical science has progressed rapidly leaving a void between the knowledge of patient and the medical condition. This leads to people being less participating in the managmment of their medical condition.

Since the introduction of expert patient by sir Liam Donaldson in November 2001 there has been mixed response from doctors, for many doctors the expert patient is the one who walk in to a clinic clutching loads of print out from internet demanding a particular medication, treatment , or a procedure which could not be suitable for them .1

This adds to unnecessary stress to already overworked doctors, the patient could be unreasonable demanding, time consuming or the worst of all patient who thinks that they know it all. These calls for a program which will develop the understandings of the patients, improve their skills in self management and self efficacy of a patient resulting in reduced visit to doctors.2

If you look at this scenario in a different manner, most patient are experts regardless of their level of knowledge. This is due to their experience of living with their medical condition and their methods or measures in managing their conditions.3-4-6-8

Most of the time people own beliefs regarding to their conditions are a contributing factor in the management of medical condition. Rarely the doctor discusses the palpability or the ability of the patient to take medication. Doctors do not understand the state of the patient those living with long term health condition and are unemployed, old or economically backward.10-11

Understanding patient’s point of view is quite important for doctors which help them in finding an appropriate medical regime which will show a positive result. This leads to formation of partnership between the patient and the doctor leading to better management of their illness.12

Sociological focus aspects of expert patient.

Despite this is being promoted by relentlessly by NHS it has been criticized for its methodology effectiveness as a self management program (Taylor and bury 2007; Wilson 2001).

Firstly The expert patient program was based on work done by Kate Lorig which has been shown to be based on misconceptions by (Greenhalgh 2009; Griffiths et al 2007). Greenhalgh has shown that expert patient program is based on psychological outcome rather then self-management leading to improvement disease outcome (greenhalgh 2009; Griffiths et al 2007; Warsi et al 2004).

Second criticism is that expert patient program is based on the idea that lay lead trainers have a greater effect than professional trainers. Professional self management programs may ignore the ways in which individuals access information.

Thirdly expert patient program may reduce the utilization of healthcare resources. This may leads to more utilization of the healthcare recourses due to greater awareness. Some time general physician failed to address patients concern and interpreted self-management as compliance with medical instruction (roger at al 2005)

Fourthly, expert patient program has been conceived as a one size fit all program.

But it tends to forget the range of social and ethical issues. The ability of an individual to engage in self-management is linked with social class where individuals with higher income groups have better focus, access and can care more actively for there chronic condition.

Thus patients from deprived background often lacks the capital and resources to effectively mange their condition. There should be more focus in recruiting people from economically challenged back ground and with low level of literacy.

Sometimes individual may have multiple conditions and it becomes increasingly difficult to manage. Children’s and young adults are less likely to be focussed for self-management which renders the expert patient program ineffective for young people.

Hence expert patient program should consider social, economical, political demographical issues