Heroes Not Zombies

I recently attended a two day “medical update symposium” for doctors at BMA House in London. I was impressed. The methods used and the organisation demonstrated were superb. One of the things we were encouraged to do after each session was to write down in the comprehensive handout three “take home” messages. A couple of days on from the event, as I think back over it, here are my three overall “take home messages” –

1. Continuity of Care. Both the respiratory physician and the dermatologist made pleas for continuity of care. The former showed a short video of a patient with COPD (Chronic Obstructive Pulmonary Disease) whose main point was how important it was for patients with chronic diseases to be able to see the same health carers over time, and the dermatologist commented how he came under pressure to discharge patients from his clinic and not follow up people with lifetime chronic skin disorders for life. So there are two aspects to continuity of care raised here – seeing the same carer and not having a chronic problem dealt with episodically. A third dimension was frequently referred to and that was the dis-integration of health care which is escalating on the back of the biomedical model (nobody used that term) which divides a person into their various diseases and disorders and attempts to deal with each of them in isolation (in the UK this is driven harder by what is called “QOF” – a system of paying GPs for reaching over a hundred different defined targets)

2. The non-linear relationship between disease and dysfunction (again, nobody actually used that language). The respiratory physician showed very clearly how a whole range of recommended and even mandatory lung function tests did NOT correlate with “breathlessness” as experienced by patients, so doctors could attain their targets, get paid, but the patient might still be complaining their life had not improved. The neurologist showed eight MRI scans of peoples’ brains and asked us to identify which one of the eight had any symptoms. ALL showed identifiable lesions. ALL but one were picked up incidentally while screening of looking for something else. That was one of the clearest demonstrations I’ve ever seen of the non-linear relationship between pathology and ill-health.

3. My third take home message was about prevention of cardiovascular disease – a subject repeatedly hammered home over the two days. Two flies in the ointment briefly appeared – in one session the presenter jokingly said that if the figures were extrapolated we’d have immortality within a few years (because stopping smoking, reducing cholesterol etc would “save so many lives”). A nonsense of course, but an important point. Exactly what are all the people who aren’t going to die from cardiovascular disease going to die from instead? Given that life has still stubbornly stuck with a 100% mortality rate.

The neurologist when discussing differential diagnoses of certain chronic neurological diseases, mentioned a particularly nasty, completely untreatable, progressive, degenerative disease and, again in a throw away remark, said you could hope the poor patient might be released by a heart attack or something before it got to this stage. I’m not arguing that preventing heart disease is a bad thing, just that it’s not an informed choice to make if you don’t consider what alternatives might then be your more likely future. (that would take me off down my hobby horse about the stupidity of basing health care on death avoidance, but I’ve done that elsewhere!)