Many of you reading this will be familiar with This is me – the person-centred document we have been using in the hospital for the past five or six years. It was originally developed by the Alzheimer’s Society working with the Royal College of Nursing, then, a couple of years ago I got together with Helen Sanderson and we re-designed the form to better meet the needs of my patients and their carers – I will explain the difference in a moment.
Since those early days, when the document was seen as something out of the ordinary, perhaps providing unnecessary clutter to the information overload hospital staff experience, it is now, at least on the wards caring for older people in Doncaster, an essential part of the assessment.
Knowing what is wrong with your patient is critical – being skilled in the practices and technology required to investigate, diagnose and treat are essential, yet, in the 21st Century we discover it is not enough.
We, and our patients do not want to be anonymous. It is acknowledged that people have preferences, hope and aspirations, fears, that are different to the rest. We are not just ‘patients’ we are Rod, or Sally or Joanne. We have expectations, anxieties and fears, that are central to our experience and the outcomes.
Successful recovery from an illness or operation can depend as much on the skill of the doctor or surgeon as well as the patient’s inner thoughts. Despair, worry and hopelessness do not engender a healthy immune system, they do not lend themselves to a positive mental attitude.
And so, to This is me. This is me – the ‘This’ capitalised, I am not sure why, but something we have done since the start, perhaps implying the importance of the document, a little like the way we use capital letters for peoples’ names and the names of cities and countries.
When we started using the document, the Alzheimer’s label led to some questioning whether it was appropriate for them or for their relatives, ‘This is for someone with dementia, my mum/dad/brother/wife/ doesn’t have dementia,’ – this coincided with the growing awareness of delirium as an entity and the reality that not everyone who is disorientated or confused has dementia, indeed, the growing realisation that dementia is more than memory led to a general broadening of understanding.
And so, this, in combination with some, what we felt important aspects of the document led to us integrating the layout with Helen’s One-Page Profiles and we created what is used across the hospital in Doncaster today, and, has been shared nationally and internationally as an example of good practice.
For those of you unfamiliar, I will attach a copy at the end of this blog. Before that are some examples of forms I have read over the years, that have particularly stood-out as representing something deeply meaningful.
This statement, which at first might seem trivial is in fact very important. Up until recently I would relate this to the conversation of, ‘I don’t like tea,’ and the real-lived experiences of patients who are offered a cup of tea multiple times a day.
If you tell someone you don’t like tea and they bring you a cup of tea, after a while, you feel that you aren’t being listened to. A little like the repetition experienced by patients during their hospital journeys… ‘Do you have any allergies?’ ‘Do you smoke?’ ‘Have you always looked this way?’ The more you are asked the same question the more you start to feel then believe that no one is listening. A ‘computer says no,’ tick-box, faceless, mentality.
More specifically, in the stroke unit, for patients who dislike bananas, this is even more important – bananas are often central to the armamentarium of speech and language therapists; the fruit can attain different consistencies, facilitating an easy way to assess a patient’s ability to swallow.
Imagine, if, because of a stroke, you are unable to communicate, and then, imagine that every few days a well-meaning person comes to your bedside and offers you your most dreaded tropical fruit, whole, mushed or pureed…
Do you like physical contact – does a hug make you feel better or, does it make you blanch? Do you like music? Would the Beatles drive you crazy or Vera Lynn up the wall? What did you do when you were younger? What was your job? Do we use jargon as you are head of the department of biomedical science or do we translate the pathophysiology into layman’s terms?
It is not just what you say, but the way you phrase your sentences, the expectations for someone who is hard of hearing but doesn’t like hearing-aid, or specs, or whatever.
We are all individuals, and, if the 21st Century has one dominant theme it is personalisation, individualisation – not yet for all citizens, but a work in progress.
And, this is the plan.
Just as you can personalise the screen of your phone, we need to tailor healthcare to your individual needs and preferences. This way we achieve better outcomes. Accepting that healthcare is an ever more expensive commodity within a world of austerity, it does not cost much to discover a person always wears a shirt and tie, or hat, or watch or lipstick.
And, perhaps in the health and social care system of the future, for, none of us know when we will be in-need, this is something we will have ready, prepared for the unexpected, like a will or life, or driving insurance.
If anyone would like a copy of the Doncaster This is me, please let me know and I will send you one.