On patient-centred care: An actor reflects on his experience as a simulated patient in medical communication skills training

The author, a contributor to a wide range of medical education programmes over many years, discusses issues arising from his work as a simulated patient, with particular emphasis on the concept of patient-centred care. While medical educators have published widely on patient-centred medicine, the author approaches the subject from the radical perspective of a medical outsider - a proxy patient. The article considers the various ways in which simulated patients contribute to communication skills training and the promotion of good practice among both prospective and established doctors. The author discusses how and how far specific consultation models may or may not be conducive to patient-centred medicine. Finally, the article assesses the present state of the patient-centred culture, as the author sees it, and suggests possible ways forward. The article is principally addressed, not to communication skills specialists, of whom there are pitifully few, but to those GPs, senior House Officers, consultants and lecturers in diverse specialisms (mainly but not invariably related to medicine) who regularly contribute to communication skills courses as managers, facilitators and assessors. It is also intended that actors in the simulated patient field will find the following paragraphs helpful in stimulating a professional debate.