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Vulnerable migrants have a right to health
Editorial
Vulnerable migrants have a right to health
For the Médecins du Monde report see http://www. medecinsdumonde.org.uk/
In recent years the UK Government has adopted more restrictive policies that seek to identify and charge failed asylum seekers and other undocumented migrants for treatment received in the National Health Service (NHS). The changes were made amid perceived fears— unsupported by any evidence—that many migrants were coming to the UK to get free NHS services. Such policies may mean that, increasingly, health care for migrants falls upon non-governmental agencies. On July 4, Médecins du Monde released the first findings from Project:London—an initiative to improve access to health care, and provide basic medical care, for vulnerable migrants living in the capital. The report highlights a particular issue around access to care for pregnant women. Of the 39 pregnant women who came to Project:London clinics in 2006, 28 had tried to access care but had difficulties either at a hospital or in a general practice. Seven of the women could not access specific antenatal services because of the high fees for maternity services under the NHS charging regulations.
Denial of health-care services to migrants who cannot pay is undoubtedly a growing issue. Studies have shown that many failed asylum seekers are destitute and will be unable to meet health-care costs. As well as making public-health and economic sense, providing free health services for this group is a human rights issue. The UK Government has ratified the UN International Covenant on Economic, Social, and Cultural Rights, which requires them “to refrain from denying or limiting equal access” to health services for all people. It calls for governments to do better at this requirement next year than they are doing now. The NHS charges flout this agreement and take the UK in the wrong direction in terms of progressive, inclusive health policies. In some European countries, such as France, Italy, and Spain, the rights of all migrants to access appropriate health care, irrespective of immigration status, are legally recognised. The UK Government can learn from these countries. It should ensure that the NHS lives up to its core principles of free health care, available to all who reside in the UK. ■ The Lancet
Evidence-based handshakes
For London’s Kill as few patients as possible see http://www. tenspeed.com/store/index. php?main_page=pubs_product_ book_jph1_info&products_id=54 7&zenid=5ee784902a1bd0881e 55937cb90cbaa9 For the Makoul study see Arch Int Med 2007; 167: 1172–76 DOI:10.1001/archinte.167.11.1172 For the Davis study see Clin Experiment Ophthalmol 2007; 35: 51–4 DOI:10.1111/j.14429071.2006.01383.x
2
In Kill as few patients as possible, a collection of darkly humorous essays written a generation ago, Oscar London advises colleagues to: “let no one leave your office without a handshake, a blood count, and a smile.” His aphorism is confirmed by Gregory Makoul and colleagues, whose research in the June 11 issue of Archives of Internal Medicine, shows that 78% of patients in the USA want to be greeted with a handshake. While the qualitative telephone interviews employed might not be the Everest of evidence, the findings do reflect actual practice among a small cohort of primary care physicians in the USA, and accord with a similar recent study by Romona Davis and co-workers. Both papers consider patients’ attitudes to greetings and the importance placed on introductions and respect as a mark of professionalism. 81% of the 191 patients in Davis’ survey believed that doctors in training should be taught to shake hands. Even more expect that the proffered hand should be washed between patients. A handshake symbolises mutual respect
and trust in many cultures. When combined with an exchange of given and family names, the greeting also communicates reciprocity and, Makoul adds, correct identification of the patient. In response to an open question, the 415 participants in his study also list other expected behaviours: smile; be friendly, attentive, and polite; make the patient feel like a priority; and make eye contact. In essence, good manners and good medicine go hand in hand. The value of exploring patient expectations lies in their ability to stimulate reflection, to improve care, and most importantly, to serve as a reminder that all aspects of practice, research, funding, and legislation should ultimately be directed to the benefit of patients. Ever since Laënnec invented the stethoscope, technological advances risk distancing doctors from their patients, and patients from the centre of health care. Hands can shorten the distance between doctors and patients, and are a precious tool for diagnosis, treatment, and communication. ■ The Lancet www.thelancet.com Vol 370 July 7, 2007
Vulnerable migrants have a right to health
For the Médecins du Monde report see http://www. medecinsdumonde.org.uk/
In recent years the UK Government has adopted more restrictive policies that seek to identify and charge failed asylum seekers and other undocumented migrants for treatment received in the National Health Service (NHS). The changes were made amid perceived fears— unsupported by any evidence—that many migrants were coming to the UK to get free NHS services. Such policies may mean that, increasingly, health care for migrants falls upon non-governmental agencies. On July 4, Médecins du Monde released the first findings from Project:London—an initiative to improve access to health care, and provide basic medical care, for vulnerable migrants living in the capital. The report highlights a particular issue around access to care for pregnant women. Of the 39 pregnant women who came to Project:London clinics in 2006, 28 had tried to access care but had difficulties either at a hospital or in a general practice. Seven of the women could not access specific antenatal services because of the high fees for maternity services under the NHS charging regulations.
Denial of health-care services to migrants who cannot pay is undoubtedly a growing issue. Studies have shown that many failed asylum seekers are destitute and will be unable to meet health-care costs. As well as making public-health and economic sense, providing free health services for this group is a human rights issue. The UK Government has ratified the UN International Covenant on Economic, Social, and Cultural Rights, which requires them “to refrain from denying or limiting equal access” to health services for all people. It calls for governments to do better at this requirement next year than they are doing now. The NHS charges flout this agreement and take the UK in the wrong direction in terms of progressive, inclusive health policies. In some European countries, such as France, Italy, and Spain, the rights of all migrants to access appropriate health care, irrespective of immigration status, are legally recognised. The UK Government can learn from these countries. It should ensure that the NHS lives up to its core principles of free health care, available to all who reside in the UK. ■ The Lancet
Evidence-based handshakes
For London’s Kill as few patients as possible see http://www. tenspeed.com/store/index. php?main_page=pubs_product_ book_jph1_info&products_id=54 7&zenid=5ee784902a1bd0881e 55937cb90cbaa9 For the Makoul study see Arch Int Med 2007; 167: 1172–76 DOI:10.1001/archinte.167.11.1172 For the Davis study see Clin Experiment Ophthalmol 2007; 35: 51–4 DOI:10.1111/j.14429071.2006.01383.x
2
In Kill as few patients as possible, a collection of darkly humorous essays written a generation ago, Oscar London advises colleagues to: “let no one leave your office without a handshake, a blood count, and a smile.” His aphorism is confirmed by Gregory Makoul and colleagues, whose research in the June 11 issue of Archives of Internal Medicine, shows that 78% of patients in the USA want to be greeted with a handshake. While the qualitative telephone interviews employed might not be the Everest of evidence, the findings do reflect actual practice among a small cohort of primary care physicians in the USA, and accord with a similar recent study by Romona Davis and co-workers. Both papers consider patients’ attitudes to greetings and the importance placed on introductions and respect as a mark of professionalism. 81% of the 191 patients in Davis’ survey believed that doctors in training should be taught to shake hands. Even more expect that the proffered hand should be washed between patients. A handshake symbolises mutual respect
and trust in many cultures. When combined with an exchange of given and family names, the greeting also communicates reciprocity and, Makoul adds, correct identification of the patient. In response to an open question, the 415 participants in his study also list other expected behaviours: smile; be friendly, attentive, and polite; make the patient feel like a priority; and make eye contact. In essence, good manners and good medicine go hand in hand. The value of exploring patient expectations lies in their ability to stimulate reflection, to improve care, and most importantly, to serve as a reminder that all aspects of practice, research, funding, and legislation should ultimately be directed to the benefit of patients. Ever since Laënnec invented the stethoscope, technological advances risk distancing doctors from their patients, and patients from the centre of health care. Hands can shorten the distance between doctors and patients, and are a precious tool for diagnosis, treatment, and communication. ■ The Lancet www.thelancet.com Vol 370 July 7, 2007