(0.047) The Speed of Snail

Thank you, Jane, for the insight into why healthcare professionals in the 21^st Century are using old-fashioned means of communication to deliver care… Perhaps, it is something more systemic, more general, a holding-on to the past?

If you compare the changes within health that are happening today with 100 years ago, you might get a flavour of the pushback.

In 1917 the October Revolution (which happened in November, but, that is another story) erupted in Russia. The Romanov’s came to an end, Lenin rose to power and centuries-old state structures were dismantled. It must have been a great time for a radical. Likely, uncomfortable if before you were sitting-pretty in a Winter Palace, watching the peasants shovel snow.

Looking this back to 1789 and the French Revolution, you can see why the other great Powers of Europe were worried.

A hundred years ago, the hospital hierarchy was established and comfortable. People knew their place. Doctor/nurse/porter – something like that (managers didn’t exist); top to bottom. Within each division there would have been consultant/registrar/houseman and so on. Everyone knew where they stood and I am sure those at the top enjoyed their position. Patients likely died as a consequence, but, you can’t go against nature. As Nietzsche might have said.

Today, the system is crumbling. The hierarchy is toppling. Ceding power is central to high quality care. When the consultant listens to the insight of the porter or student nurse, you are on to something. When the patient determines the ward-round times or which investigations they prefer, the world is changing. More than a top-down I say, you do, it is, we say, we do, we reflect. The true complexity of the challenges is apparent.

I was involved in an interesting clinical case recently – here it is in outline:

Patient A has experienced funny dos. At times she collapses, sometimes loses consciousness, at others she is vacant for a few minutes. This has been happening for years.

Patient A has heart tracing Y.

Tracing Y (from Google)

Cardiologist sees Y and says A must have a pacemaker. That is why they are ill.

Old system > (this is for non-emergency situations), specialist > tracing Y > pacemaker.

New system > vacant > tracing Y > patient preference/explore what is happening/weigh the risks/calculate the benefits>consider alternative causes or treatments. Think then act rather than the other way around.

I am not sure if that made sense. In essence, the change is a shift from doing to, to doing with. From passive recipient of care to partner.

The consequence – you might decide to go left instead of right. You might consider my opinions irrelevant. You might make a daft decision. (And this within a society that voted for Brexit.)

And if you start to dismantle the fundamental structures of hospital and care, what remains?

You likely encounter situations where 90-year-old Enid refuses to get into the ambulance to take her home from the hospital at three in the morning, James, 80 asks for a second opinion or, Callum 50 who has been self-administering for the past 40 years asks to look after his own insulin.

It is reimagining ward rounds and multidisciplinary meetings, where the patient is central, the main character in their story. Where, the grit in the engine makes something special, is more than an inconvenience.

And, moving at the speed of a snail is inadequate. Care at the speed of a quill is absurd.

Radical has become a dirty word. It has never been more essential.

The Winter Palace Ball, 1903.