Silent partners. Patients' views about choice and decision making in a day unit

The profile of day case surgery has been gaining prominence in the last decade. Improvements in surgical techniques have allowed a greater range and number of surgical procedures to be performed on a day case basis. Day case surgery also offers considerable efficiency benefits, with lower cost per case than the equivalent in patient treatment. Consequently, the number of surgical day cases has been increasing rapidly although considerable variation still exists between districts. A further advantage of day case surgery arises from its compatibility with the consumerism inherent in the health service reforms. The flexibility and speed of day case surgery permits a response to consumers' demands for a service that meets their needs rather than the hospitals. It offers a reduction in waiting times and the choice to avoid the arduous and often traumatic experience of being admitted to hospital. Bowling, in a short review of the research evidence, suggests that day case surgery generally meets with consistently high levels of patient satisfaction. The most welcome aspect of the recent health service reform is, perhaps, the emphasis on patients' rights and individual choice. Nurses, who are often the closest to the patients, have frequently drawn attention to the need for partnership, and an informed and participative relationship with the patient. While the Department of Health's genuine commitment to patient choice and participation may be little more than skin deep, in the case of day case surgery it appears that consumption and the improvements in efficiency desired by the government may be compatible with nurses' aspirations for greater patient choice.