How often do we get a chance to think and reflect these days? We are pretty caught up in the doing, performing as the doctors and nurses we have been trained to be. But if you stop and have the luxury to think a bit, it does make you wonder if we are ploughing on with the right sort of ‘doing’?
We tend to steer by the guiding lights of evidence-based medicine, well synthesized and simplified from the mountains of research that most of us are too busy, or ignorant, to contemplate. Mostly it comes from clever and ever more sophisticated biomedical insights.
The trouble is, as I see it, as we adopt the ever more complicated matrix of pathways and best practices, we move further and further away from the person at the centre of our mission. If we find it complicated to juggle and deliver the ‘must do’s’, how does it feel for the patients? If your practice is anything like mine, we have less and less time to consider what matters most to the person, and it becomes secondary to pursuing the perfect medical solution.
The noise back from patient groups and advocates like National Voices is increasing in volume – “please make sure you consider our wishes”; “please be clever, but not so clever that you lose us along the way”. The same message is permeating the leading independent health think tanks such as Nesta, the Health Foundation, and the King’s Fund.
Those that do have time to think (that’s what think tanks do!), are increasingly drawing us back to the realisation that the clever bit is only half the story, the person mustn’t be forgotten. Even more than that, in terms of what makes the biggest difference to the health of people living with long term conditions, it is the ‘person bit’ that has the biggest effect on outcomes. What people do for themselves, as individuals and communities, to look after their health is more important than what we do as healthcare systems. Personally, I find that the more you listen, the more you notice this is the message coming back from most of the consultations I have too.
So for me, rethinking medicine is a rebalancing process, a time to reflect on whether we have the right proportions of ingredients in our good health recipes. It is certainly not discarding the incredible progress that modern medicine has made, and the ‘miracles’ it has allowed us to achieve, but an opportunity to enhance these by reinforcing them with ways to enable the person-centred approaches too.
William Osler, the wise grandfather of medical schools as we know them, said: “The good physician treats the disease, the great physician treats the person with the disease.” I wonder if he were listening now whether he might suggest that great physicians work in partnership with their patients to both treat disease and create good health.