You are fit… medically fit.

This isn’t something that you often hear doctors or nurses telling their patients. Instead, it is a communication tool used inside hospitals to convey certain information between different people. What does it mean? Does medically unfit mean that there is something terribly wrong, and, does medically fit signify that all is well and there is no longer any disease?

There are formal, internationally recognised definitions of health – for example, the World Health Organisation described it back in 1946 as a ‘state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’

Reading this definition, how many of us are healthy? I suspect, very few. I mean, I don’t see myself as being ‘unhealthy’, but I certainly don’t tick all the requirements of the definition, and that is me… and I don’t have that much wrong with me.

Does this definition suggest that the majority of us, have some sort of health thing going on? You could argue, that if you were a business person, this would be fantastic – it is like defining your customer – you don’t need all the new diseases that keep appearing in medical journals and TV programmes, you just have to look at yourself in the mirror, and, if that doesn’t work, use an ultrasound, x-ray or head to the lab for a set of blood tests.

So, is health, as much help in the understanding of disease as ‘medically fit’ – well, to explain a little more, or attempt to provide a definition of MF (there is another abbreviation used commonly in hospitals ‘MFFD’ – which stands for, Medically Fit for Discharge – this is an extension of what I am trying to describe; I’ll start with ‘MF’ first)

Medically Fit, essentially means, ‘A person has reached a state of clinical or physiological stability that is unlikely to be associated with the need for further inpatient hospital care in the near-future’ – near-future, using the department of health’s terminology, is probably within 28 days (or sometimes 30 days, depending on who is counting).

So, what does this term do for us? Well, my perception is, that it is used most commonly when discussing older people in hospital who no longer need to be occupying beds. That is, when a younger person is OK, or at least well enough for home, we don’t usually tell them, or say amongst ourselves, they are MF, we just say, ‘home,’ there is no need to set the organisational wheels in motion to facilitate discharge – that is, the transfer of that person from being a hospital patient to being either a person again, or at least a patient in another part of the complexity that is the health and social care system – with the latter referring to people as ‘clients’

I guess, people might be wondering why I seem to be making such a fuss over this terminology, for surely, if the WHO can’t get it right, does it matter if UK hospitals can’t seem to work out what terms to use?

My problem lies with the misinterpretation of MF – for, depending on the clinical environment, this term has different meanings and connotations, it could mean – as good as it’s going to get, the likelihood of things going wrong is small, get the social worker or even, ‘the doctor says, ‘home’’

I am not upset at having this ability to influence the lives of others – I am sure it must do my ego some sort of good, it is just, that is it such a nebulous term, so open to interpretation and manipulation, after all, one doctor might say MFFD, another, with all the same information, but different experiences and biases might feel, the need to organise another inpatient investigation, treatment or test.

This comes to the core of medicine, more as an art than a science, and just as there is supposedly no bad art, saying what is bad medicine is tricky; although, having studied in Dundee, most people there have no problem in agreeing what bad poetry is, thanks to Mr McGonagall… (aka ‘el kabir’)

Is there a way to overcome this stalemate? Well, my usual, tried and tested solution to most problems with clinical care or treatment is probably appropriate – ask the team – that is, the patient, the family, the nurses, physios and doctors, think, ponder, analyse what is the best, most appropriate thing to do – this sort of shifts the medical hegemony and means that the door to home swinging-shut because the doctor hasn’t said so is less of an issue, less dominant as a concept.

The next time I don’t write ‘medically fit’ or something along those lines, please, (and this is a message to those people who read these things), don’t assume ‘not’ – assume that there is a gap in the information, don’t assume that people need to be patients or that the default is ‘not’ – let the default be, perhaps the starting-point, that most people are medically fit (and not by nature hospital inpatients), most people are healthy, using whatever definition you like – ideally, Jon Kabatt-Zinn’s, which says that, so long as you are still breathing, there is more right than wrong with you.

So long as you are still able to participate, join-in with the conversation, your perception of self is just as valid as that of the doctor or nurse.

Health, medical wellbeing or fitness is not a spectator sport – it is an active, ever evolving wonder that can only approach the level of purity which we seek if as much information, and relevant, that is person-centred, and, based on personal preferences is at its core.



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