BMJ 2014;349:g5743 doi: 10.1136/bmj.g5743 (Published 23 September 2014)
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Observations
OBSERVATIONS BMJ CONFIDENTIAL
Angela Coulter: Loves patient involvement, hates pomposity Who is the person you would most like to thank and why? Robert Maxwell (King’s Fund), Tom Delbanco (Picker Institute), and Al Mulley (Informed Medical Decisions Foundation), for opening up great opportunities for me.
To whom would you most like to apologise? What was your earliest ambition? To be a potter—an unrealised and unrealistic goal.
Who has been your biggest inspiration? I was greatly inspired by Jack Wennberg’s seminal work on variations in medical practice and the complex factors that influence medical decisions. Also, Al Mulley and Michael Barry showed me how evidence based practice and a patient centred approach could be combined through shared decision making, to deliver more appropriate and more effective healthcare.
What was the worst mistake in your career? Many—but I’m not tempted to make a public confession.
What was your best career move? Escaping academia for the cut and thrust of policy debates at the King’s Fund.
Bevan or Lansley? Who has been the best and the worst health secretary in your lifetime? Bevan was best, of course, but I was too young to remember him. I can just about remember Barbara Castle’s welfare reforms and Patricia Hewitt’s smoking ban—both noteworthy achievements. Lansley’s legacy is largely disastrous, but his championing of “No decision about me without me” was a positive step for patients. John Moore wins the prize for the worst, most useless health secretary (1987-88). For personal use only: See rights and reprints http://www.bmj.com/permissions
My clarinet teacher—I was hopeless.
If you were given £1m what would you spend it on? Mental health is an under-researched and ill promoted priority, so I would give the money to any charity that would put it towards ensuring much more effective support for people with mental health problems and their families, to make a positive impact on public understanding.
Where are or were you happiest? On walks and picnics in the Haut-Languedoc with my family.
What single unheralded change has made the most difference in your field in your lifetime? The development of evidence based patient decision aids. We now know a great deal about how to present complex information on benefits and harms, to help patients participate in important decisions that affect them. The next task is to persuade clinicians to make this available for their patients to use.
Do you support doctor assisted suicide? I wasn’t sure until I read Tess McPherson’s moving account of her mother’s last days (BMJ 2012;344:e4007, doi:10.1136/bmj. e4007), which crystallised the issue for me. Now I think that all doctors should be willing to provide relief for extreme suffering at the end of life.
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BMJ 2014;349:g5743 doi: 10.1136/bmj.g5743 (Published 23 September 2014)
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OBSERVATIONS
Biography Angela Coulter argues that medicine without full patient engagement lacks a key dimension. For eight years from 2000 to 2008 she was chief executive of Picker Institute Europe, which advocates patient centred care; she now works for the Informed Medical Decisions Foundation and as a researcher in Oxford. Paternalism is the past, she insists: the future must see patients recognised as partners in their care and experts in their own conditions—an ambition to which clinicians and health service managers regularly pay lip service, but which has yet to be realised. Coulter is 65.
What book should every doctor read?
What personal ambition do you still have?
The Silent World of Doctor and Patient by Jay Katz. And, although not in the same class, I hope they might also read my book, Engaging Patients in Healthcare.
To persuade doctors that patients should be given sufficient information to let them participate in decisions about their care—and that not doing so causes them harm.
What poem, song, or passage of prose would you like mourners at your funeral to hear?
Summarise your personality in three words
I hate to think about funerals, but Monty Python’s Always Look on the Bright Side of Life might make them giggle.
What is your guiltiest pleasure? Walnut Whip.
If you could be invisible for a day what would you do? I would snoop on pharma pricing discussions to find out how the companies justify their colossal charges for treatments that offer only marginal benefits to patients.
Clarkson or Clark? Would you rather watch Top Gear or Civilisation? Neither—I prefer Borgen and Spiral.
What is your most treasured possession? My iPad. I still find it astonishing that you can find answers to almost any question simply by tapping a screen.
Persistent, self reliant, sceptical.
Where does alcohol fit into your life? A glass of Faugères rouge slips down nicely.
What is your pet hate? Arrogance and pomposity.
What would be on the menu for your last supper? Scrambled egg on toast with Marmite.
If you weren’t in your present position what would you be doing instead? I’m very content with my current portfolio—a bit of research, some speaking, some writing, some tweeting; and, at last, some time to think. Cite this as: BMJ 2014;349:g5743 © BMJ Publishing Group Ltd 2014
What, if anything, are you doing to reduce your carbon footprint? Our roof is covered with solar panels.
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