Last week I came across a post on Facebook that caused me to stop and think about the very nature of the post. So what was it that caused this momentous event for me to write an entry here about it?
There was a picture, photograph actually, of a notice that had purportedly been placed in the GP surgery, by the GPs practice, stating that each appointment would be restricted to one condition per consultation. It was the kind of printed poster done on the cheap on an office printer «Verb Tense has shifted.» that we all seen in offices throughout the country.
This in reality this picture is fairly innocuous, but the author of the post on Facebook that grabbed my attention wrote, “Very telling if today’s treatment of people but very worrying. Imagine someone who has knee pain, low back pain, shoulder pain and is suffering from regular migraines. So thé dr has to treat thèse as separate issues…..yet thé chances are they are all linked. How many years on pain meds before that patient gets help that addresses all those issues?” Excuse their grammar and quite why a french keyboard option had been selected is and remains a mystery, but that way you can see that the post is unedited.
This was followed up with further comments regarding how disgusting this notice was and hating to think how many millions of NHS money is wasted when a more holistic approach would be far more effective.
I did initially respond on this thread but with reflection of a few days I wanted to write a more considered and detailed response.
I should at this stage confess if that’s the right word to having worked in the NHS for 13 years, not as one of the miracle workers such as clinicians, but sadly what could only be described as a pen pusher. However during those years I’ve seen many things that give me not necessarily unique insight into the NHS but certainly a more detailed one than many.
A more holistic approach would almost certainly be of great benefit to each patient seen. However, the reality of such an approach would be to totally grind the NHS to a halt. The sheer volume of patients that have to be seen does lead to the feeling that patient going through a hospital episode, be that outpatient, or inpatient is rather like being in a factory, starting at one end moving through the various stages until being discharged at the other. This, sad as it may be, is in fact, the only way that the demands we all place upon her health service can cope. At present if you are unfortunate enough to be an inpatient, you are admitted in various tests are organised all under the supervision of a named doctor. Therefore, when the test is required instruction is submitted to the relevant department that organise that test, another type of test would receive a separate instruction to that department and so forth and so on this may seem under joined up to the untrained eye, but it is merely making economies of scale to allow the needs placed upon the service to be met. Imagine the alternative approach, whereby one patient will need several tests will need to speak with several nurses, consultant, pharmacist, and doctors. Now instead of the patient being sent to each of these, the scenario where the pharmacist, the consultant the nurses the doctors all come to the one patient. The time wasted in doing this would be horrendous although holistically care wise would seem better the individual patient. To quote this from the Star Trek films, the needs of the many outweigh the needs of the one.
It is of course so easy to throw words around expressing how disgusting the NHS is how it would be better for different approaches, but it is based upon simplistic view, a view that is well-founded.
Turning though to GPs, on average each GP is allowed nine minutes to deal with each patient. Yes, nine minutes that includes getting the patient from the reception area to the doctor’s room talking and examining the patient diagnosing what is wrong and what is required writing any prescriptions or referrals, and returning the patient to the main reception area. All that in nine minutes. A holistic approach, by a therapist, in a private setting is normally based upon a period of one hour. So in that our when the therapist is taking the time to discuss the way in which the person’s activities are restricted in their pain levels, as well as delivering treatment, a GP would have seen over six patients.
Now I am the first to admit this but I’m not a fan of GP practices; I think there is much scope for improvement in the customer experience. However, they are working within a framework that is decreed to them and they have to make it work with ever-increasing patient numbers, ever increasing patient demands and ever increasing inspections by overarching regulators. They also have to deal with patients whose expectations are unrealistic who will demand referrals to hospitals, antibiotics for non-appropriate illnesses and expectation that everything can be cured instantly. GPs also face the worst that society can throw at them in terms of behaviour, being faced on a daily basis sexism, racism, aggression, and plain rudeness. And yet they remain the when we need them. Yes, we can always get to see them as quickly as we like, can you always get into your therapist as quickly as you would like?
So although I agree with the sentiment regarding holistic approaches every avenue has its place, be that modern medicine, holistic therapies, talking therapies, or physical therapies. Each therapy can compliment another, and even if one is successful where others have failed, does not mean that it is necessarily a better approach, it was just the right one at that time. But most importantly always try to understand the difficulties that are faced by those who are so quick to judge.