This week, the spotlight
has well and truly shone on consultations, in the form of several reports
released by the Health Foundation, including one entitled ‘When doctors and
patients talk: Making sense of the consultation’ (Health Foundation, 2012).
This is welcome news to
us, as consultations and how they are conducted, and helping health
professionals develop more person centred skills, has long been a central theme
of our work. This is because we know that people with diabetes have mixed and
often unpredictable experiences with their health professionals, and frequently
spend days and even weeks before their meetings feeling anxious and concerned
about what might happen, particularly about whether they might hear bad news
about their health. Not least of their worries is being judged for not
achieving better control of their blood glucose, without the chance to explain
the complexity of managing diabetes day by day in the face of other pressures
and demands. As one person memorably put it ‘consultations for me are about
attending to receive my ritual telling off’ (although in reality the words
‘telling off’ were said in rather more colourful language!). Another lady put
it like this – with tears in her eyes -
‘I feel like I’ve failed an exam every time I go to the clinic’.
The Health Foundation
review, which is based on extensive interviews and workshops with a range of
doctors and patients, not only completely validates this aspect and discusses
fear of patients as a key influencer of their participation in a consultation,
but also suggests that the fear of doctors is a factor too. Their fear centres
on making the wrong diagnosis or on potentially being regarded as less
professional if they alter the way they work. With the power in healthcare
still largely residing with the health professional, the consultation is often
structured to allay the fears of the doctor rather than the patient, giving
rise to the experience of many of being talked at rather than with and being
unable to fully express their thoughts, feelings and wishes.
It’s not all bad news for
consultations of course - many go very well, and the bond between health
professionals and the people they see is often close and productive. Diabetes
UK’s magazine ‘Balance’ runs a regular column ‘I couldn’t do without…’ in which
people describe where their best support comes from. This very often features a
nurse, doctor or other health worker. What we need is more of these obviously successful
encounters and less of the ones that are, frankly, a waste of time and effort,
not to mention money, for all concerned.
But the good news is, a
knight in shining armour may be coming to the rescue. A new way of working is
hovering on the edge of diabetes care, looking for ways into the mainstream.
This is personalised care planning, which features shared decision making at
its core and has been shown to be successful in transforming the routine,
health professional-based consultation to one that is truly collaborative, to
the satisfaction, and in many cases delight, of both health professionals and
people with diabetes.
With personalised care
planning, people with diabetes are able to have a much greater say, literally,
in the consultation, and no longer have to wait in trepidation for their own
test results (blood, eyes, feet and so on) to be given - or often partially
supplied - to them by their health professional. Personalised care planning
means they receive a comprehensive set of results and have time to reflect on
them well before their consultation. They can then make decisions in the
comfort of their own home before meeting up with the health professional to
talk about what aspects of their diabetes, if anything, they wish to work on as
a priority. Quite often, they attend having already made a decision about
changing something, and have got started on it, so saving a lot of time which
can then be used to discuss other aspects of their health or make for a shorter
consultation.
Health professionals are
naturally sceptical and need convincing about new practices, an aspect
highlighted by another of the recent Health Foundation reviews on the evidence
for shared decision making in consultations (de Silva, 2012). This review
describes principles that are known to promote shared decision making, which
happily including many that feature in personalised care planning, such as:
goal setting and review; making care plans in partnership together; emphasising
options; problem solving; and preparation for the consultation in advance.
However, even though this evidence is available, health professionals are also
as vulnerable to the difficulties of changing their practice and behaviour as
anyone else, and for these reasons, personalised care planning has not yet been
widely implemented.
Fortunately, the body of
evidence for personalised care planning is increasing all the time, and we are
proud to be contributors to this in a number of ways:
·
Our website
resources, including workshops (Successful Diabetes, 2012)
·
2 recently published
papers (Walker et al, 2012; Walker and Rodgers, 2012)
·
Our book explaining
the nuts and bolts of how to set up personalised care planning (Walker and
Rodgers, 2011).
Now, with the Health
Foundation’s timely reviews, we sincerely hope that services will be able to
stop saying ‘why should we?’ and see that ‘how can we?' is the only question
they need to ask!
Does anything in this blog
ring true for you? Do you have experiences of consultations or personalised
care planning... or the opposite? Post your thoughts and comments and share them with us here…
References
de Silva, D. (2012).
Helping people share decision making: a review of the evidence considering
whether shared decision making is worthwhile. Health Foundation. http://www.health.org.uk/publications/helping-people-share-decision-making/
Fischer, M., Ereaut, G.
(2012). When doctors and patients talk: making sense of the consultation.
Health Foundation. http://www.health.org.uk/publications/when-doctors-and-patients-talk-making-sense-of-the-consultation/
Successful Diabetes
Workshops http://www.successfuldiabetes.com/workshops
Walker, R., Rodgers, J.
(2011). Implementing Personalised Care Planning in Long Term Conditions. SD
Publications. www.successfuldiabetes.com/books
Walker, R. et al (2012).
Introducing personalised care planning to Newham: outcomes of a pilot project.
Diabetic Medicine, 29, 8, 1074-1078. Abstract can be viewed at
Walker, R., Rodgers, J.
(2012). Personalised care planning for long-term conditions. Diabetes and
Primary Care, 14, 3, 177- 181. Online at
