In this blog, I interchange the words patient and service user and refer to a clinician as a service provider- anyone that provides healthcare services, including physicians, surgeons, nurses, midwives, technicians, therapists, etc.

Recently I have had multiple discussions around  this question “ How can I advocate better for myself in a healthcare setting?” The question was frequently preceded by a recollection of events and experiences where individuals did not feel like their health teams heard or prioritised their ideas, concerns and expectations around their care.

Not being heard, Not being told.

This is not uncommon. Evidence suggests that clinicians interrupt patients within 20 seconds of speaking and only spend 5% of the conversation answering questions. Sometimes patients and health service users report that when interacting with health care providers, their concerns are dismissed, not heard, or they feel they are not taken seriously. The opposite can also occur, where people feel overwhelmed because they have been given too much information with medical jargon and are burdened with making the final decision.

Doctors, nurses and midwives are human too.

This may be obvious, but I wonder whether service users, politicians, and the media occasionally forget this. I feel that the narrative around health service providers and users can be polarising with the false image of us being on opposite sides. This is far from the truth. We are on the same side. We want the same thing. Most of us come to work to do good for patients and service users.

Despite our shared goals and humanity, multiple things get in the way of our good intentions as providers:

1. ·    Lack of time

2. ·    Low morale & poor job satisfaction

3. Relatively more responsibility than

   the power to create organisational

   change.

4. ·    Variable access to real-time data

5. ·    Access to more skills in

   communication, collaboration &

   technology

6. ·   Clunky technology that is not user

   friendly.

Health workers and service users want human and flexible healthcare, focusing on the needs of both service users and service providers.

This is the main message of the recently published  Reimagining Better Health Care Study, which surveyed the opinion of 2000 hospital-based clinicians ( doctors, nurses, technologists, therapists, and technicians), 5500 hospitalised patients and patient advocates and interviewed 24 clinicians, patients, patient advocates, health researchers and policy experts across 8 countries in North, South America, Europe and Asia Pacific region( why did they miss out Africa?).

This study was conducted on the backdrop of sobering trends in the health workforce globally:

• By 2030, there will be a 13% gap in the size of the global workforce required to meet patients’ needs.

• clinicians are burning out

• PATIENTS LACK TRUST AND CONFIDENCE

The results echo the findings of the 2017 Realistic Medicine report, which advocated for prioritising innovation, reducing clinical variation and waste and promoting personalised care through shared decision-making. Shared decision-making is an approach that supports people as equal partners in making informed choices about their treatment and care. To do this, clinicians need to understand what really matters to people and practice active listening and information sharing ( benefits, risks, alternatives treatments, including doing nothing) to involve and empower service users in their care.

Shared Decision Making takes time but also saves time.

Time is probably one of the greatest barriers to shared decision-making. However, shared decision-making can free up time by allowing providers to get to the core of what actually matters to patients and service users quickly and then tailor the conversation to address this.

THERE ARE ALWAYS at least two experts in the consultation room.

Recognizing the value of clinical and lived experience expertise is crucial as they are different yet equally important. Patients' unique experiences of their medical conditions provide valuable insight and expertise that healthcare professionals should respect and always consider when providing care. By acknowledging this, healthcare teams can provide personalized care that caters to individual needs and concerns.

As a service user with lived experienced expertise, you can facilitate shared decision-making by asking the following questions:

1.    What are my options?

2.    What are the pros and cons of each option

for me?

3.     How do I get support to help me make the

right decision?

4. What else could this be( what is your

differential diagnosis of my symptoms)?

As healthcare workers, we can encourage patients to share their thoughts and concerns by simply asking, "What matters to you?" I understand that it can be awkward to ask this question, but I always try to approach it in a way that feels authentic to me and my communication style.

To ensure that you make the most of your upcoming appointment with your gynaecologist or any other healthcare professional, it is crucial to communicate your concerns and priorities to your medical team effectively. Additionally, I would like to suggest the FiveXmore community resource, which provides valuable information on advocating for yourself in healthcare settings.

1. Speak up and ask questions about your care ( alternative explanations /differential diagnoses, benefits, risks and alternative treatment options, including doing nothing)

2. Bring a friend or family member who can advocate for you on your behalf; they may also help remember parts of the discussion that you forget.

3. Seek a second opinion; you are entitled to one if you feel you need to.

4. Trust your ‘gut’; if something doesn't feel right, speak up, share your concerns, and ask questions to help you clarify your situation.

5. Do your research using trusted websites like NHS.uk, RCOG Patient Information Leaflets,

6. Write things down to remind you of your questions and discussions of benefits, risks, alternatives and resources that have been shared with you.

As always, do comment, share and get in touch if what you’ve just read resonates with you', or if you have questions, drop me an e-mail.

Useful Resources:

• Shared decision-making in realistic medicine, what works: https://www.gov.scot/publications/works-support-promote-shared-decision-making-synthesis-recent-evidence/pages/3/

• Understanding Risk: https://www.rcog.org.uk/for-the-public/browse-all-patient-information-leaflets/understanding-how-risk-is-discussed-in-health-care-patient-information-leaflet/

• FiveXMore 6 Steps to Advocate for Yourself: https://www.fivexmore.com/6steps