Kate Eisenstein is an experienced leader in public policy, strategy and engagement, with a background in health, social care and local public services. She writes this blog in a personal capacity, but is currently Assistant Director of Insight and Public Affairs at the Parliamentary and Health Service Ombudsman.
As someone who has spent most of their career in health and other public services, I am a passionate advocate for the power of public services, including the NHS, to transform lives for the better. As someone living with multiple long-term health problems, I am no stranger to NHS care myself.
Since becoming unwell with another new condition last year, attending medical appointments has effectively become an additional part-time job. If I’ve learnt anything from this experience, it’s that rethinking medicine has the power to utterly transform the experience and outcomes of care for both clinicians and patients.
To illustrate, let me tell you about two of the many medical consultations I’ve attended recently. Both appointments were with experienced consultants from the same clinical sub-specialty. Both were first-time appointments in a specialist outpatient clinic. Both took place in large teaching hospitals in central London. Both would have cost the NHS the same amount of money. Consultant number one - let’s call them Dr Smith - seemed to have decided what treatment was right for me before we met. I was told to start taking a drug that may address the symptoms of my new condition, but may also leave me with severe side-effects that would impair my cognitive and motor functioning - two things that feel pretty important to me, in my work as well as in my social and family life.
The power balance between patient and practitioner can only be one of equals if the practitioner creates the right conditions. In this instance, I felt not like a person, but like a cluster of symptoms that should be treated at any cost to the quality of my life. Strangely enough, I did not rush to my pharmacy in rapid pursuit of the new drug I’d been told to take.
Fast-forward to consultant number two - let’s call them Dr Jones. Dr Jones asked many questions, not just about my symptoms, but also about what was important to me in life and what I expected treatment to help me achieve - to be able to work, to socialise, to do the things that make life worth living. Dr Jones listened, and asked more questions. They wanted to understand the psychological and emotional impact of my physical health. We discussed that any treatment for the latter would be much more likely to succeed if we also addressed the former.
High-quality care means recognising that patients are people too - not just a 'symptoms puzzle' that needs solving.
Then, together, we developed a care plan. Not one that will guarantee good health or eliminate adverse side effects, but a realistic one, built around an intent to find a balance between symptoms and side effects, to make me well enough to work and to play, without crippling me with fatigue, confusion, or immobility. In other words, we used our combined knowledge and expertise to create a treatment plan intended to make life worth living. What is the point of medicine, for patients and professionals, if not that?
High-quality care means recognising that patients are people too - not just a ‘symptoms puzzle’ that needs solving. Engaging patients as equal partners in our care isn’t just a nice thing to do, it is the only way to understand what a good clinical outcome looks like.
This isn’t just for the benefit of patients. In my professional and personal experience, people who choose to work in healthcare do so because they want to make a positive difference to people’s lives (I certainly do). As a policy wonk and as a patient, I know that goal is much more achievable if we rethink medicine.