It’s not looking good. It would be nice to think that things are getting better, but they’re really not looking good. More and more of us are getting dementia, and cancer, and diabetes, and more and more of us are getting dangerously fat. Even in a world where there was plenty of money to throw at a problem, this would be quite a problem. But in the world we face it’s looking much more like a bomb that’s going to explode.
It would be nice to think that the 467-page Act that the government has forced through on health and social care will address the problem, but it won’t. What we need in health is a change that’s much more radical than this. What we need in health is a very, very, very big change in the relationship between people who get ill (which is all of us at some point) and the people who are meant to make them better when they do.
At the moment, the relationship is a bit like a bad one between a parent and a child. The child is the kind of child who eats what he likes, and drinks what he likes, and sometimes nicks a bottle from the back of a kitchen cupboard, and sometimes nicks a fag. The parent is one who also eats what he likes, also likes a fag, and who doesn’t do any exercise, and is a bit tired and cross. The parent will see the child if he has to. He’ll make an appointment (at a time that suits him and not the child) and then pass him on to somebody else. And then he’ll send him to a hospital, because hospitals are what you need to heal the sick.
Hospitals aren’t what you need to heal the sick. Hospitals are where you go when you need to have a tumour cut out, or to have a blood vessel moved from one bit of a heart to another bit of a heart, or if you’ve got an infection that needs to be monitored all day and all night. But hospitals aren’t much good if you’ve got dementia, or diabetes, or smoke a lot, or if you’re just very fat.
What sick people need is a partnership. We need to have a relationship with our doctor, or a ‘nurse practitioner’ at a local health centre, who we see before we get ill. We need to work, with that doctor, or that nurse, on developing plans to keep us well. We need to be able to look at those plans, and at our progress, and at our medical records, online. We need to be able to email that doctor, or nurse, to ask questions and get advice. And when we need to see him, or her, we need to be able to make an appointment online, and at a time that fits in with our work. Since many of us have to work evenings and weekends, we will expect the people who are in partnership with us (in doctors’ surgeries, and health centres, and hospitals) to work evenings and weekends, too.
What we will expect in this partnership is a relationship that works both ways. We will expect to do more to keep ourselves well. We will expect the health service to provide better systems to help us when we’re not. We will, for example, expect phone calls and emails to be answered, and appointments to be fixed in good time, and files, and X-rays, and blood test results (which will now be stored, with our records, in a ‘health cloud’ we can access) not to be lost. We will expect to be treated like an adult, and spoken to like an adult, and we will not expect anyone to treat us as if their time was more precious than ours.
And if we have to go into hospital to have an operation, as I have had to do six times in the past eight years, we will expect the staff to treat us in the same way they would treat their mother, or friend, or child. We will expect them to remember that they are doing these jobs because they chose to do these jobs, and that we didn’t choose to be ill. We will, in other words, expect the people who look after us, when we’re at a low point in our lives, to do the jobs they were employed to do, and also, though you shouldn’t have to say it, to be kind.
Christina Patterson is a writer and columnist at the Independent. She has written widely about her experiences as a breast cancer patient, and has campaigned to improve standards in nursing.
@queenchristina_
Comments
It is not always the case that people are unwilling to change but they may be unwilling to be changed.
If advice is framed from the health professional perspective and not the patient, the patient may perceive the recommendation to be inappropriate for incorporation into their life.
Lack of change is often attributed to poor compliance, but blaming or labeling a patient as non-compliant may damage self-esteem and create a barrier to future behavior change.
Non-compliance could be described as two people working towards different goals.
When patients do make changes using the compliance approach, the change is often externally motivated, i.e. carried out solely to please the health professional, as such the effect may not be long-lasting.
I believe that this works just as well if we transpose patient and clinician.
There is another area I think we need to explore, and this is true systems thinking. One of the mantras of systems thinking is: For every pound of data you get an ounce of information, for a pound of information you get an ounce of knowledge, a pound of knowledge gives an ounce of understanding, and a pound of understanding leads to an ounce of wisdom. We acquire knowledge but have to develop understanding so that we might act with wisdom. I would also add the following hierarchies:
Instinct, emotion, empathy, compassion and enlightenment.
Materials, products, skills, talent and creativity.
I was also given a copy of Ian Kennedy’s Reith lectures from 1980 a few years ago, when the same concerns were expressed, albeit with a little more balance. Ivan Ilich’s medical nemesis from 1975 was another text that warned of where we were going, as did Balint’s seminal text from the 1960s, when he described the ‘collusion of anonymity. These are only a fraction of the warnings that have been sounded but we continue to give power and authority to politician’s who seem ignorant of all of this wisdom.
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