Perioperative medicine training resources: U4M11: Patient advocacy in the intraoperative period

Abstract
This edition of Future Hospital Journal has a focus on person-centred care and explores the dimensions to partnership working at three different levels - consultation, service and system levels. In this introduction, the authors explain what they consider to be the essential components of person--centred care and what needs to be done to embed it at all levels of healthcare delivery. The changing attitudes of patients and the desire of most of them to receive personalised care based on their individual needs, preferences and lifestyles are explored. It is argued that a culture change is needed to make person-centred care the norm and that patients can help deliver this through a more meaningful involvement in medical research, training and education, service reconfiguration and commissioning.

Abstract
It remains unclear what patient advocacy actually entails and what values it ought to embody. It will be useful to ascertain whether advocacy means supporting any decision the patient makes, or if the advocate can claim to represent the patient by asserting well-intentioned paternalistic claims on the patient's behalf. This is especially significant because the position of advocate brings with it certain privileges on the basis of of presumed insight into patient-perceived interests, namely, entitlement to take part in clinical decision making and increased professional standing. Three issues related to patient advocacy will be explored: are patient advocates necessary; what does advocacy entail, and who ought to represent patients in this way-arguments for and against prospective candidates will also be covered. The paper considers whether advocates are necessary since not only can they be dangerously paternalistic, but the salutary values advocacy embodies are already part of good professional health care.

Abstract
Purpose of review: This review is designed to update readers on recent discussions and research regarding vulnerable populations in medicine, including patients who are socioeconomically disadvantaged, queer, in prison or labeled with a stigmatizing complex medical disease.

Recent findings: Recent studies have more closely examined the effects of being part of a vulnerable population. Greater societal income inequality impacts those at the lower end of the income curve by increasing mortality and heightening the importance of individual personal situations. Recommendations from an extensive WHO report on the social determinants of health may affect social policy and use of public resources in Europe. Clinicians are undereducated about the lives and concerns of vulnerable populations, including LGBTQI persons, immigrants, physicians, prisoners, and families of patients with diseases considered 'incompatible with life'.

Summary: Greater understanding of the cause of the health effects of being socioeconomically disadvantaged or being a member of a vulnerable population may be the first steps toward specific policy recommendations. Professional medical organizations and advocacy groups should raise awareness, provide education, publish guidelines and define the goals for the medical care for certain vulnerable populations.Vulnerable populations are at risk for disparate healthcare access and outcomes because of economic, cultural, ethnic or health characteristics. Vulnerable populations include patients who are racial or ethnic minorities, children, elderly, socioeconomically disadvantaged, underinsured or those with certain medical conditions. Members of vulnerable populations often have health conditions that are exacerbated by unnecessarily inadequate healthcare.