Physicians in a foreign land?

Working as a physician, it would be easy to discard the current rhetoric of a ‘patient-centred NHS’, after all that’s surely why the NHS exists. But, in spite of its shortcomings as a concept, I suspect the arrival of the ‘expert patient’ is just the start of a new kind of patient at the centre.1,2 The relationship between the public and professionals is changing: the age of deference is coming to a close. Increasingly patients will be more questioning, more demanding and better educated about their problems. Diabetes is an excellent example and many diabetes services, led by imaginative physicians, are showing the way in bringing innovative approaches to patient education, making patient empowerment a reality. Of course some patients will continue to ask the doctor to take all the decisions but increasingly patients will seek a different relationship; a relationship based on concordance rather than compliance; a relationship of adult to adult, rather than adult to child. I envisage this, like parent/child relations, as a continuum in chronic disease management with the gradual transfer of knowledge and skills to the newly diagnosed patient to the point where they are able to take control themselves. And with control comes responsibility: when a child becomes an adult they take responsibility for their own actions, and do not blame the parent – provided, that is, the childhood was a positive experience. This will have implications for training and delivery. It will probably also require more time, initially at least, which leads to my second challenge.