I feel most uncomfortable about the direction of health care delivery in England just now. It’s not just the supermarket type of ethos of purchasers and providers which I dislike, but it’s the compartmentalisation of human experience into boxes labelled “disease” or “risk factor”. This reduction of a human life to “manageable” units each of which can then be dealt with by any faceless and nameless practitioner is deeply disturbing.
Surely health and illness are human experiences? Neither can be properly understood from averages and statistics. Neither can be understood or engaged with meaningfully without consideration of both the personal, subjective experiences which the patient relates through their unique narrative, nor without consideration of the contexts of an individual’s life. But more than that – isn’t health care a human activity which cannot be understood outwith the human relationships of those involved? Doesn’t it matter exactly who the doctor is?
Lord Darzi is promoting the development of polyclinics (also rather offensively I feel, referred to as “one stop shops”) where many, many doctors work in the same building. He says the days of personal relationships with individual doctors are behind us as most single handed practitioners now practice in at least groups of 4 – 6, so what’s the difference if they practice in groups of dozens? Aren’t they all interchangeable?
I really disagree. Who says that an individual practitioner is a bad idea? Take a look at Tom Bibey’s blog for a most excellent example of what a single handed doctor can do. Clinical practice is about people, not populations. A trusting relationship built up between a patient and an individual doctor is worth its weight in gold. We only see this being devalued when we move from a concept of health care which reduces human beings to diagnostic categories.
I would suggest that what health care needs to do is to enable the creation of better, personal, holistic services and that will only be achieved by putting “whole” people, and human relationships, at the heart of the plans.
Health and illness are about people. It’s personal medicine we need, not processing plants.
Heroes Not Zombies 
I could not agree more.
There isn’t a single physician in my world; they all work in groups. While I LIKE this idea – that many doctors work in the same building and have the opportunity to interact (there’s that third mind again), I DISLIKE being cycled through them as though any old doctor will do.
When I call to make an appointment for any of us, I schedule it so that we can see OUR doctor, not whomever happens to be available that day. I dislike being treated like a “case” and passed around to whomever’s free at the time. I want to have a relationship with my doctor; I want the consistency of his or her knowing me (or my child or my husband) and of being able to pick up on the subtleties of our demeanor, not just our “condition.”
Honestly, I think it’s this DE-personalization – not just in medicine but also in education and service industries and, well, just about everywhere – that’s at the heart of some of the problems we face collectively as a society. If we don’t feel that anyone cares for us, why, then, should we care about anyone else? It’s this sort of thinking, I believe, that leads kids to solve their schoolyard issues with guns.
It is. That’s the heart of it. De-personalisation, de-humanisation even. I firmly believe this is the key thing we need to shout for these days – for a person-focussed perspective on these things – we need to refuse being commodified – we need to resist the attempts to make us into zombies!
https://heroesnotzombies.wordpress.com/2007/04/06/how-to-make-a-zombie/
Bless your heart Dr. Bob. I might be eccentric, but at least no one is ever gonna say I’m a zombie. I consider that a most high compliment.
And you are right, the patient is everything- without them it is time to go home.
Dr. B
There is another point which needs to be made, which is that human relationships work both ways. As the spouse of a GP, admittedly I’m not exactly unbiassed, but I believe that doctors also deserve consideration if they are to provide the personal, holistic services which you are urging. But from what I can see, this is very difficult for doctors to achieve these days, especially GPs – at least, here in the UK. The concept of patients as “consumers” of health services, the struggle to manage patient numbers against limited resources of money and (even more importantly) time, the ever-increasing volume of targets, assessments and other paperwork, the increased likelihood of complaints and claims if things go wrong, and now the demand that GPs extend their opening hours – all these are resulting in a great deal of stress, overwork and demoralisation amongst GPs. I’m very lucky to have a truly excellent GP, with whom I have an excellent patient-doctor relationship, and like Mrschili I’m always able to make a point of seeing him when I need to make an appointment, but I don’t want to abuse that relationship. Put whole people and human relationships at the heart of health plans – absolutely right, but doctors need respect and consideration as well as patients, and I’m not at all sure that they’re getting it these days.
Well said Martin. Maybe I didn’t make it clear enough but that’s exactly my point – medicine is about human beings and as you rightly say it takes two to make a relationship. What I think we need to argue for is that this very fact should be at the heart of our priorities and plans. Doctors are not interchangeable clones and they are not robots that you can program to carry out clinical algorithms. Please, oh please, let’s have health care organised around the recognition that it’s about human beings – not drugs, not statistics, not management processes or whatever – all of those things should be tested against the endpoint of the human experience – that of the patient and that of the doctor.
Martin, the pressures you outline are at the heart of why I stopped being a GP. I was lucky to find a facility within the NHS to allow me to be the kind of doctor I always wanted to be. My wish for other doctors is that they too can find or can help create the services which allow them to practice according to their values and goals too (I’m assuming here, that most doctors did actually choose their profession in order to help others). If I can stimulate and encourage the voices of those who demand health care focussed around the human-ness of doctors and patients I’ll have done something worthwhile I reckon.
Thanks for that, Bob. It’s perfectly clear, from several of your comments on your blog, and from the responses from a great many people, that you are already doing all this stimulating and encouraging – keep it up! You’re very fortunate to have been able to make the switch from general practice to a job which you clearly love. In my own way, I’ve been lucky too – I’ve enjoyed my various jobs over the years (albeit not with quite the same sense of vocation as yours). But I do sometimes feel that those of us who derive any kind of job satisfaction from our work are in a dwindling minority these days. Why can’t the powers that be just let us all get on with the jobs we thought we were signing up to when we started?