Have I been getting it wrong all along?

6 December 2011

Bethan Graf

One evening last year, I was sitting with James discussing the NHS and our roles within it over a pint of Guinness. He was one of the hospital managers of the trust I was working at and, before long, I was complaining about the ‘useless’ targets that had become the bane of all clinicians’ lives, specifically about the four hour wait in A&E and the dreaded breach. He asked me who I thought was behind it. ‘Lots of office type people who have no idea what is best for patients’ I quickly (and a little smugly) replied. 

‘It was actually your patients that drove it. They were asked what would make their A&E experience better, and that’s what they wanted – to be seen quickly and a timely decision made about whether or not they needed to come into hospital’. 

‘Oh’ I replied. 

‘Yes’ he said. 

On the way home on the bus I thought about our meeting. Not only were James and I wanting the same thing for the NHS (albeit coming from very different directions), but he seemed to know more about what my patients wanted than I did.

It made me think: when was the last time I actually asked a patient what they wanted? Without even realising it, I’d become incredibly arrogant about presuming I knew best, just because I was the doctor and see patients every day. How had I managed, within six years of qualifying, to completely lose sight of the patient - the real purpose of my job?

That meeting was part of an initiative, set up by Bob Klaber and others at Imperial College NHS Trust, called Paired Learning. With the aim of bridging the gap (or chasm) between clinicians and managers it invited specialist registrars and managers within the trust to meet and mentor each other. I got involved wanting to learn more about why managers make the decisions they do. Never in my wildest dreams was I expecting such a wake-up call. 

Following on from Paired Learning, I was invited to join a group of medical students, junior doctors and managers on a study tour to Sweden. Funded by the Health Foundation, its aim simply was to join together a group of likeminded individuals all wanting to learn more about how we could improve healthcare in the UK.

We were shown multiple examples of how they were managing to shift the emphasis to total patient-centred healthcare. One scheme, Esther, is designed to improve care for their elderly population. Co-ordinating care between hospital and community teams, it ensures that every individual elderly patient receives the best care they require.

In another example, clinics allowed patients to fill in online questionnaires prior to their appointment. The emphasis of the appointment was therefore focussed on what they wanted to discuss and the wider picture of their wellbeing, rather than whether their toe hurt more than their finger (it was a rheumatology clinic and as a side product had got their waiting times for new appointments to just two weeks).

They’d even gone so far as trying to create a ward round where patients came to a private room to discuss how they were, allowing far more privacy and dignity than a hospital bed and ‘sound proof’ curtains. Relatives could join too, if they wanted, and often they would have a physiotherapist and occupational therapist there too.

Now I’m not saying that all of that would be transferable over here in the UK, and even what could be would take significant time and effort to achieve. But it has left me thinking: shouldn’t I at least be trying?

Why do I spend my time seeing well people in clinic whose disease is under control, and then when they deteriorate tell them the waiting time for clinic is two months? Why do I admit people to hospital when they have a much better set up at home, don’t actually need hospital therapy specifically, just because we ‘that’s what we always do’?

I’m ashamed to admit that in a lot of cases, hospitals and doctors work the way they do because history dictates, and because it suits us. I’m hoping over the next year to try and change some of the ways my clinics work by introducing a telephone-led clinic or even by email or an online form.

I’m expecting resistance, and know that it will take time. Until then though, I’m spreading the word amongst my colleagues. How many patients have you asked what THEY want today?

Bethan is a specialist registrar in Gastroenterology at West Middlesex Hospital.

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