At a meeting today run by the Yorkshire and Humber Strategic Clinical Network for Dementia, I listened to a presentation from Laura Middleton Green, a lecturer in palliative care working at Bradford University. She discussed some of her recent research relating to the care people receive at the end of life; as part of her PhD research she spent time observing the care of people who were dying in hospital.
Laura presented a tripartite model of care which mirrored to some extent the medical versus person-centred model I have previously described.
Laura’s model divides care in hospital into three categories – acute care which focuses on treating, curing or getting better as the principal value, care of older people which has at its core rehabilitation – helping people to return to a level of function as good or as close to that which they had before admission – prior to the fall, pneumonia or stroke, and, thirdly, palliative care, where the goals are solely focused on supporting an individual at the end of their life – prioritising quality over quantity.
I found this fascinating. The models of care I have talked about in previous blogs allude to the medical model being that which allows pathology, physiology and biochemistry to dominate – a philosophy driven by the scientific method as applied to care, the other, the one which is person-centred, focuses not only on the science, on the data, but also holds the person, who they are, where they have come from, their hopes, fears and desires with equal parity to their sodium level or the subtle speckling of a chest x-ray.
I don’t think the two models are that different and throughout my time in medicine I have seen the very close association between the care we offer older people and palliative care, indeed, I spend much of my life walking a tightrope between therapeutic, data-driven medicine, with its invasive devices and investigations and the soulful conversations with relatives, patients and carers, where caring is the best we can do.
The model I prefer, the one which trumps all others, for me at least, is that which involves everything – the patient, the person, the data, the emotions, past and present, hopes and fears, together with blood counts, X-rays and microbiology.
It is this privileged existence that I try to convey to the medical students who work with me on the ward – what could be better – working within science and the metaphysical, the harmonious synchronicity of mindful being and state-of-the-art clinical science?
And the three-way model of Laura’s maps directly on to this; how fantastic an experience would we be able to offer our patients, when they are admitted to our assessment units or intensive care, where the best of modern multidisciplinary medicine is thrown at them – central lines, intubation, haemofiltration, and, we see them as whole people, we offer holistic care, support and treatment, of their whole person, which includes their family and friends and the trauma they might also be experiencing (yes – getting rid of visiting times is part of this!)
Seeing the person buried underneath the tubing and gadgetry, how liberating!
And this model flowing seamlessly into the downstream elements of care – the chest or cardiac ward, the surgical or diabetes units, all treating people with the best possible, evidence based interventions, simultaneously overlaid with the person, only treating those who want treatment, or for whom it is appropriate; this might seem complicated, it isn’t really – it involves taking your time, seeing that the person in front of you could be you, or your mum, or dad, sister or brother, connecting with them, listening to what they or their loved ones have to say, communicating as equals, within a team of equals, openly and honestly, lovingly.