Patient feedback should be at the heart of the e-portfolio
Asking for feedback from patients should be a mandatory requirement of the foundation programme and medical school
When I reflect on how I performed a procedure or talked to a patient, I am often left wondering: “What did the patient really think?”, “How did that make the patient feel?”, and “Did the patient think there was any way in which I could improve?”
Asking for feedback from patients is a compulsory part of the General Medical Council’s revalidation process, which doctors who have their certificate of completion of training go through every five years. Yet when it comes to the foundation programme, it’s optional. In our e-portfolios we have to record our competency in carrying out 15 clinical procedures and our performance in a minimum of 64 supervised learning events over the two years, but there’s no mandatory requirement to ask patients what they think of us.
In the absence of a formal process for recording feedback from patients, I asked some patients under my care for feedback during one shift to see if it would make a difference to the way I practise.
After I had inserted a cannula in a patient she told me that she liked the fact that I had asked her where she wanted to have it sited. She said that during a previous admission a cannula had been inserted in her right elbow flexure without consultation, and this had affected her ability to write, get dressed, and carry out personal hygiene. This example highlights how feedback from patients can help us to see the effect of our care and the points where we can improve. Feedback from patients emphasised to me the importance of good communication skills and giving patients a choice. Several other patients I spoke to said that they would like more opportunities to give feedback at the bedside because it could improve the care that they and others receive in the future.
One patient I spoke to said, “It would be very hard for me to tell doctors about things they have done badly, simply because of the perceived power difference. I need doctors to be on my side.” Patients need to be able to trust us. If doctors make it the norm to ask patients for feedback—and it is valued and applied—patients are likely to be honest with their feedback without fear that it could affect their care.
As part of my day to day practice I now make more effort to ask patients what they think. This can be a challenge because sometimes we think we are too busy to ask for feedback, let alone reflect on it. I try my best.
Patient feedback should be at the heart of the e-portfolio, along with a record of our competency in clinical skills. The feedback could help avoid failures in patient care. In his 2013 Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, Robert Francis writes that there needs to be improvement in the means of measuring and understanding the performance of individuals and teams for the patients and the public. If we are serious about putting patients first, we need to start listening to them and acting on their feedback. This starts at medical school and during the foundation programme, not just when it comes to revalidation.Marina Soltan, foundation year 1 doctor
Queen’s Hospital, Burton, West Midlands Deanery, UK
Competing interests: None declared.
Provenance and peer review: Not commissioned; not externally peer reviewed.
- Soltan M, Powell R. The new foundation programme curriculum. Student BMJ 2016. http://student.bmj.com/student/view-article.html?id=sbmj.i4590 .
- Francis R. Report of the Mid Staffordshire NHS Foundation Trust public inquiry: executive summary. 2013. http://webarchive.nationalarchives.gov.uk/20150407084003/http://www.midstaffspublicinquiry.com/sites/default/files/report/executive%20summary.pdf .