Person-centred mainstream?

I gave my annual lecture to the Sheffield University Medical Students on Thursday.

It was the hottest day of the year.

I have been standing in front of the students for something like 15 years – since I was training to become what I am today, a doctor obsessed with person-centred care, helping older people, getting along, making work fun;

Over time, the narrative has changed, the conversation evolved.

Thursday was unusual in that my lecture had been postponed from January – the move to Rotherham had disrupted plans and so, this lecture was both just before exams and sandwiched in the middle of lectures about endocrinology.

Consequently, not that many people turned-up, which in a way was good, as it was a more intimate gathering, particularly as they had to sit near the front, away from the extreme condensed heat at the top of the auditorium, which enabled me to attain a better connection with them.

What transpired however is that from the early days when my description of person-centred care, holistic assessment, frailty, polypharmacy and so on had been at the time (at least to me), radical, to the students, these were all things they had heard before, despite only being in their second year of training.

I don’t think I bored them – only two people left in the middle (a new phenomenon, although, I did at the beginning say they could leave if they weren’t interested).

It was both breath-taking, exciting, enlivening as well as kind of sad that things have changed. I am no longer the guy that tells the story about doing what is right for the patient (person) rather the system or the doctors; there has been a cultural shift within medicine and healthcare in the past probably five years that has been incremental but significant.

No, it’s not sad, it is overwhelming, amazing, incredible.

From sitting on the periphery, I had a sense that what I was saying was moving towards the mainstream.

This isn’t to say, that the poem I just wrote, about advance care planning and conversations about the end of life are the norm within current-day medical practice, yet, they are taking-place more often, they are no longer the outside exception to the rule.

The students fed-back that they appreciated the stories I told, the anecdotes relating to patients who have stood-out, stuck in my memory. The man colonised with MRSA who wouldn’t remove his beanie hat, the woman whose greatest wish was to not die in hospital. The experiences where my feelings and emotions have become interconnected with my patients and their families. Where my destiny has become a miasma of self and others.

It used to be that at the end of the lecture, one or two students would come and tell me how much they appreciated what I had said, on Thursday no one came, that, I feel, because my words were no longer that radical.

Imagine the conversation…

Che: Hasta la victoria siempre!

Man on the street: We’ve had the Revolution, things are better now, you can chill.

Che: Tequila?

Mots: Sí, señor!

A little like this;

What becomes of a revolutionary when things have changed? Looking for some new dawn to conquer, some place to seek growth or expansion, the peripheries.

Talking with my friend Helen yesterday, reflecting on some of this, and the changes we have seen in our short lives, and, with it both the satisfaction of growth or the establishment of communities and groups saying more of the same thing, allayed with the consideration of, What is next? Where from here?

The students suggested I bring a patient next time, perhaps; there are few things worse than making people listen to what they already know or abstract lessons that don’t make sense; perhaps, a lecture consisting solely of stories.

Professor, any thoughts?