Yesterday the Department
of Health announced a new rating for GP surgeries – marks out of 10 for
‘patient experience’. The rating is designed to enable people to make
comparisons between surgeries when deciding which surgery to register with. A
score of 10 is high and it is based on information given in the patient’s
survey, a questionnaire given to a random selection of people visiting their GP
after their consultation. You can see the ratings on the NHS Choices website.
A key new factor included
in the rating is ‘whether doctors and nurses are good at explaining things and
listening to people’ – part of the job description of a health professional,
you might think, and certainly this factor is welcomed by the Patient’s Association
who say they hear increasingly from people who are not listened to effectively.
However, this seemingly straightforward aspect of a consultation being rated
has raised some strong feelings among healthcare staff. A comment from a
practice manager in the health professional online magazine ‘Pulse’ yesterday
was that maybe patients should be rated on their ability to listen as many problems arose because
of people ‘failing to remember the basic information they have been told’. This
comment drew a number of ‘well said’s from other contributors, among them a GP
who felt that ‘It’s about time patients' responsibilities were highlighted as
well as doctor’s’.
It sounds from all this,
as though both patients and doctors feel frustrated – patients because they
don’t get enough time to take in information properly, and doctors and other
health professionals because their attempts to give the best care are hijacked
by government pressure and targets, for example having to deal with a number of
medical issues in only a 10 minute consultation. When stressed like this, it’s
not surprising that both parties are tempted to blame the other.
But could there be another
suspect entirely that is to blame for the mismatch between expectations and
reality? namely the system in which care is delivered. For example, we have
often heard from health professionals who have been given extended consultation
time alongside undertaking a course, to help people manage their diabetes more
effectively (‘Insulin for Life’: Chaplin, Widdowson and Reeve, 2012). They
report that they found the benefits of conversing with people in a more relaxed
way about their lives, challenges and hopes and dreams was incredibly useful,
not to mention satisfying. Even more importantly, this approach improved
outcomes for both patient and
health professional.
This would seem to suggest
that, in long term conditions at least, that systems need to change to
accommodate the needs. In the above example, many GP surgeries also began
dedicated clinics for diabetes as a result of their experiences, and have found
it a really effective way of meeting the needs of people with diabetes. This
suggests that there needs to be a practical and meaningful stimulus to make
change happen.
By coincidence, an
editorial in recent edition of Diabetic Medicine (Cradock and Cranston, 2012),
addresses just this point. The authors suggest that much more ‘emotional
mastery’ - support for people with diabetes to deal with the stress caused by
taking care of their diabetes - is needed alongside ‘insulin mastery’ (dealing
with the practical aspects). This suggestion is based on research showing that
at least some diabetes-related stress may actually come from the diabetes
consultation itself. This is because traditionally, the consultation places
medically-based expectations on the person with diabetes, causing feelings of
anxiety and guilt and thus contributing to raised HbA1c levels. Creating a
system of care which places much less emphasis on insulin and much more on
reducing the emotional effects of diabetes may well be an important factor in
reducing HbA1c – the ‘holy grail’ of most current diabetes services.
Perhaps the findings of
such a model could be shared with health services as a whole and adapted so
that both health professionals and people using their services can feel less
pressured, less blamed and become more healthy as a result? After all, as
Einstein himself said: ‘doing the same experiment over and over, and expecting
different outcomes… is the definition of insanity’. Perhaps given its benefits,
healthcare professionals may not be so defensive about changing the experiment
to include more listening?
References
Chaplin, S, Widdowson, J.,
Reeve, B. (2012). The Insulin for Life programme: nine years on. Practical
Diabetes, 29, 2 (supplement)
Cradock, S., Cranston, I.
(2012). Type 1 diabetes education
and care: time for a rethink? Diabetic Medicine, 29, 2, 159-160
Department of Health
(2012). Government opens up data to benefit patients and GPs online
