People not patients #1

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Why am I so dead-set against patients? Yes, that is a funny position for a doctor, yet it isn’t that strange – I don’t know when the idea of ‘patient’ first started, but I am sure it was in a time before modern medicine, likely when doctors, or probably, shamans were prancing about in the firelight spitting and throwing dirt at unsuspecting children.

I am sure the patient, the ‘one who suffers’, (I promise I will stop using this term, from the Latin, when I have exhausted its use) in those days was likely suffering, with their smallpox, measles, ague or consumption, whether an ache that couldn’t be assuaged or a falling away, a deterioration to the often inevitable death.

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Now, we are in a very different place, yes, we have a growing number of chronic and terminal diseases, many of which have been compressed into the latter years of an individual’s life, but also many of which have either been curable – infections, treatable – stomach ulcers or manageable – asthma, diabetes, HIV.

It seems to me that the whole relationship between the patient and the doctor is different to that which we all swore an oath at graduation. We still need to follow the ethical principles described by Hippocrates, and we need to stick to the useful advice of our governing body – for UK doctors, the General Medical Council. How much else is changed?

In addition to the different ways to manage or treat disease, we have, recently discovered, or possibly, re-discovered person-centred care, listening before treating, acknowledging the wishes, the aspirations, hopes and fears of those who come to our door for treatment.

We still however follow this very traditional model of doctor-patient, the latter again calling on the Latin, meaning, ‘to teach’ – (Is this what happens in schools these days? Is teaching student (person)-centred?)

People come to hospital and are treated as patients, they are stripped of their identities and if unlucky, managed in a purely medical model – they become a disease or constellation of symptoms, and, if more fortunate, are listened to with sensitivity and their opinions and values acknowledged. We still, however, treat them as patients.

We collude in the creation of the sick-role, in the pyjamas and slippers, the meals in bed or at the bedside; we take responsibility for administering drugs, which for people with diabetes or Parkinson’s, for example, can result in errors in dosing and timing.

We need to un-do this process, reverse the creation of patients – yes, we need to listen, to care, to work hard and long into the night (and the weekend Jeremy) to find answers, to find ways to improve the lot of those who seek our support.

The entire model of care in hospitals needs to be turned upside-down; many of those in acute hospitals in the UK, usually the old and the frail, although receiving excellent diagnosis and treatment for their medical conditions, are often diminished, worn-down by the systematisation.

Let’s exchange the pyjamas for clothes, the slippers for shoes and let patients manage their own medicines; let’s ensure that preferences are acknowledged and visiting times are replaced with opening times, which given hospitals are hospitals, should be 24/7, let’s provide free Wi-Fi, let’s give people the opportunity to decide when they will come to an outpatient appointment and whether there is a sound reason for the investigation that they are having, let’s Trip Advisor health and allow people to filter by preference, let us enter into negotiations and discussions instead of passive submission, let us let the people fight and let us fight with the people.

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