Andrew Rix is an independent research and evaluation consultant, and Honorary Researcher at Swansea University School of Medicine.
At the end of the recent Rethinking Medicine webinar, I felt uneasy. At one level the 'movement' is repositioning medicine in the broader context of the socioeconomic determinants of health and wellbeing, but in practice what is happening on the ground is the development of a whole range of changes to service delivery, concerning both the 'what' and the 'how'.
New ways of thinking are leading to new ways of working, changed relationships and, most importantly, a reappraisal of the position of evidence-based medicine and the role of the patient.
We heard of a 'narrative' to plot progress, but it seemed to be mainly a retrospective account of initiatives that been tried and have attracted support.
The central tenet of managing healthcare (at least publicly funded healthcare) is reducing unplanned hospital attendances.
A patient who attends hospital in an 'unplanned' way is seen as a potential failure of the system. The system should have looked after the patient better outside the hospital since once in the hospital, everyone could pay a high price for this failure: the public purse pays over the odds for quite possibly unnecessary care, and even iatrogenic damage to the patient.
The trouble is that despite all the attempts to keep patients away from hospitals when their problem shouldn't really 'need' hospital care, their numbers keep going up and up.
I was recently on the 'other' side of receiving care, as a relative of a patient. I had the opportunity to have a front row seat in viewing the exchange of communication between different healthcare professionals and said patient. Or should I say, the lack of communication.
In urgent care, the triage nurse tutted and sighed when we asked how long it was going to be until my relative was seen….to point out, this was after four hours of waiting without any form of communication. After waiting close to five hours, we received the required referral to the surgical team.
This question became prominent during the study because patients' understandings of 'care' often seemed at odds with those of healthcare professionals. What particularly puzzled me was that healthcare professionals often espoused concepts of good care such as 'shared decision-making', while patients found that the interactions involved did not meet their needs.
While healthcare professionals thought they were 'sharing decisions' or 'involving' patients, patients could simultaneously feel that they were struggling to 'get a conversation' with the doctor or nurse.