Advance Care… the future?

400px-Be_Francis_I_at_dying_Da_Vinci_Louis_Gallait

Healthcare in the UK, and probably, the rest of the world is in a bit of a mess. I appreciate that is quite a generalisation; I will elaborate…

We have access to the most unbelievably sophisticated medical treatments no matter where you live in the world – it just so happens, that in some places, you have to be very rich to access them, in others, like the UK, they are universal and free, for the time-being.

Today, I was on a critical care unit, with staff who are able to perform feats of incredible techno-biological sophistication.

Yet, that isn’t the problem.

The issue is that we have, for many, many people in our society, tools, either high or low-tech that are able to determine the microscopic, even biochemical nature of disease, or, more commonly which are able to predict the future outcome of an individual’s care or treatment.

We have become incredibly able to say whether an individual is in their last year, three months or few days of life – this is something that doctors don’t always get right, although when using the methodology of multidisciplinary care – involving all those caring for the patient – nurses, doctors, relatives, etc., as well as, the patient, the diagnostic yield is much higher.

We however do not use this information to anywhere near as much effect as we could. People who we know are in their last year of life, typically Ping-Poing between health and social care, with no one taking the time to sit down and explain the situation, namely, that, the outlook is poor, things are getting worse.

We can look at quantity of life – something we have very little influence over, or, we can address, quality – an area we can influence tremendously.

We need to be up-front with our patients, not necessarily blunt, but we need to steer the conversations down avenues that lead to them gaining a better understanding of their prognosis. Not how likely they will recover from their ‘UTI’, but how likely they are ever to return to a quality of life that is equal to their expectations.

And that, is Advance Care Planning. I have yet to meet a patient who knows entirely what they want –who tells me, from the outset, ‘Here, doc, I have it all planned-out, I don’t want another CT or another blood test,’ or even, ‘Please stop checking my blood pressure every four hours.’

I have had conversations where people have expressed this wish, to me – principally, because I am receptive; there does, however, need to be something that people, whether patients or not, can carry with them to direct the health and social care symphony, to allow the wishes of the individual to be translated into the complexity of the system.

ADVANCE CARE PLANS

Clinical care in the UK is becoming harder and harder to deliver with any sense of consistency or quality, particularly in the winter months, when systems are stretched to their limit;

Only through planning ahead, having the patient’s voice centre-stage, before things collapse, can we hope to provide the person-centred care that we would all desire, and that, often, is care away from the frontline of diagnosis and technological assay, and often, closer to the sunshine, closer to the fresh air, sound of waves, chirrup of birds or human contact, of hands held in empathy and understanding.

Next time, I will write an example of an Advanced Care Plan…

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