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The Changing Patient of the Future - From Passive Recipient to Active Participant

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The Secretary of State for Health, Jeremy Hunt, was questioned by the BBC today on views expressed in a five year old letter to a constituent.

The letter defended NHS funding of homeopathic hospitals and the question was whether the Health Minister thought homeopathic medicine worked.

That was the wrong question. That was not what his letter - written while in Opposition - actually claimed. It had emphasised that healthcare was to be "patient-led".

Put crudely, that means having the NHS pay more attention to what patients want, rather than imposing upon them what it thinks they should want.

And many patients want homeopathy, as Hunt's letter points out.

"Homeopathic care is enormously valued by thousands of people and in an NHS that the Government repeatedly tells us is "patient-led" it ought to be available where a doctor and patient believe that a homeopathic treatment may be of benefit to the patient."

A better question, then, would have been whether or not the new Secretary of State agrees with the previous government that NHS care should be increasingly patient-led.

According to a Twitter discussion earlier this summer on "the patient of the future" medicine needs to go further still than just giving patients a voice in the kind of care available. The care clinicians offer will need to be increasingly patient-centred.

The Tweet-exchanges hosted by the Mayo Clinic's Center for Innovation - including healthcare professionals, journalists and patient advocates - focused on what tomorrow's patient could expect. A central theme weaving its way through the answers was the "continued evolution of patient from passive to active", as highlighted by a healthcare blogger. A breast cancer survivor insisted such activism will demand much of doctors, including the "two-way street" of "respect and partnership". And the Center's Fran Dickson said the "patient of the future needs to be center of the care team, involved in all decision making".

Are physicians ready to offer that? And are all patients ready to accept it?

To do so, a mental shift is required away from what the Center for Innovation describes as healthcare's "unacceptable" status quo.

Of course, such mental shifts can be tough.

Some years ago colleagues and I were in a meeting with a medical expert who had spent decades rising through the ranks to a senior position. The lively discussion centred on the need for patients who wanted it to have freer access to spiritual solutions for their healthcare. The particular spiritual care being focused on was my own practice of Christian Science. Ideas flowed freely between the consultant and my colleagues.

Until, that is, the penny dropped for him.

It was not that he was against spirituality in healthcare. He liked the idea. But the consultant suddenly glimpsed how this kind of spiritual care inverted the medical model he had worked with for decades, in which patients primarily handed responsibility for their care to physicians. In conscientious spiritual care the patient is taking responsibility for their own wellbeing, although they can enlist the aid of an experienced spiritual practitioner.

It was moving to hear this seasoned health professional frankly disclose how anxious it would make him feel as an individual healthcare consumer to relinquish his dependency on others. He was clearly uncomfortable with the concept of patients actively participating in their healthcare - one of the things I most deeply appreciate about the particular approach I take.

Now, however, it seems the tide is at least turning in that direction.

During a recent debate in Parliament's upper house the cross-bench peer and noted neurologist Lord Walton of Detchant assured the House of Lords: "All medical bodies, including the BMA and the General Medical Council and others, now agree that the days of doctor's orders are long past."

The transition of patients from passive recipients to active participants, then, is clearly a work in progress within the current system.

But many people also want more options available to them. As Jeremy Hunt pointed out, that includes homeopathy. It also includes mind-body medicine and the demand for this has been evidenced by NHS provision of cognitive behavioural therapy and mindfulness. And for many, like me, it also includes spiritual care.

What role, if any, should the NHS have in funding mind-body medicine and alternative medicines like homeopathy? It is a legitimate subject for debate, and one that Jeremy Hunt inherits in his new in-tray.

However, the inevitable diversification of healthcare is a step of progress many are increasingly pursuing of their own accord. Even clinicians are voting for alternatives by using non-mainstream treatments for themselves, according to recent surveys in the UK and the US.

In the brave new world of patient-led care, not everyone will agree with everyone else's choices.

But as we stop seeing ourselves primarily as machines in need of fixing a more holistic approach is emerging - one that celebrates a patient's often overlooked understanding of their own needs and the best way to meet them.