Person-centred care & Perthshire

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Today, I heard about a system in Scotland to help people refer themselves to their local memory clinic. In England and probably all of the world beyond Perthshire, the system is that people wait until their memory, emotional or cognitive decline has deteriorated to an extent that they can no longer ignore or avoid the matter, see their GP and are referred to the local memory service for assessment.

In Perthshire it is different – people can self-refer. This is something that is very much against the culture of the NHS: people taking their health into their own hands and deciding what to do. The standard gatekeeper role of general practitioners becomes sidelined in this system.

The fascinating thing is that, by empowering people (not patients, they haven’t arrived at that point yet), letting them control the gateway to assessment, those in the greatest need, who often would normally wait the longest are getting help earlier.

In particular men, who classically play-down any physical and in particular psychiatric symptoms until it is too late. In Perthshire, more men are being diagnosed with dementia earlier – this results in people learning sooner about their condition and having greater opportunity to be involved in treatment and care planning, reducing or at the very least, delaying the point at which they require inpatient, hospital, residential or nursing care.

Funnily enough, when people are allowed to self-assess, to direct themselves without the process-driven machinations of medicine – the receptionists, the waiting room, the triage systems, they are quite able to tell when something is wrong and needs addressing.

Imagine if the entire health service were to operate this way – I am not suggesting we get rid of General Practitioners, rather, we change their role; no longer the gate-keepers, but the guardians, the advisors of health, the translators of disease and diagnosis.

Flipping the model from patient – doctor to person-person; equals, who are able to open-up safely and securely to one another, share ideas, no matter how silly, daft or frightening.

When John Lennon sang about ‘Power to the People’ I don’t imagine he was thinking about 21st Century Healthcare, but never could the need be greater than today, to do things differently, to turn the system upside down.

Whilst the doctors are the experts in disease, the patients are experts in themselves, their own health, their own physiology, anatomy and biochemistry. If we take our time, tip-toe slowly and cautiously enough to perceive the hidden messages in gestures and expressions, we can hope to move closer to that model of health and care that places the patient at the centre and everyone else playing second-fiddle.

Egad, is this person-centred care?

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