Heroes Not Zombies

“seeing the person in the patient” caught my eye as I read this letter in last week’s BMJ –

The key to the successful management of comorbidities (and all illness) is to “see the person in the patient.” That is not easy for doctors who see patients only briefly and tend to use that time to focus on their patients’ illnesses. At 68 years of age and with a fine collection of comorbidities of my own, I speak from experience. The key to success in treating comorbidities is to discover what motivates patients, what their ambitions and aspirations are, what they would like to be able to do, and then to agree with patients an individual care plan that accommodates all of their conditions, is practicable from their point of view, and which will—as far as possible—enable the fulfilment of those aspirations. Kamerow is right that dealing with such patients is logically a primary care issue but, in the UK at least, that is not simple. In my GP practice, I rarely see the same GP twice in succession, so continuity of care has something of a hollow ring to it. Perhaps there is a case for a GP with a special interest in comorbidities, or are there so many of us with comorbidities that no GPs would be left to treat acute illnesses?

The letter is written by Peter Lapsley, who is described as the BMJ’s “patient editor” (not sure what that is, but I really agree with his comments). He was writing in response to a piece by Kamerow about the difficulties in dealing with patients who have more than one thing wrong with them – “comorbidities”. The problem is that the reductionist approach to illness compartmentalises people into bits, trying to find and define the wonky bits (my term!) and fix them. This approach uses guidelines and algorithms created from reviews of research into treatments for individual diseases – pretty much always conducted on patients with just one thing wrong with them.

Actually, as Peter Lapsley points out, the problem is resolved by focusing on the person instead of the individual diseases.

The trouble is that takes time, a holistic, patient-centred approach, and a real effort to understand what’s important to the patient and responding to their aspirations and values. It absolutely is not a one-size-fits-all approach to health care. It’s time to stop trying to squeeze everyone into protocols and rediscover the value of both continuity of care and the importance of focusing on the human, or the “person”. This is especially true when dealing with people who have long term conditions.

(I’ll declare an interest here – where I work we deliver 100% continuity of care, and we completely focus on the individual and help them find a way to better health according to their aspirations and values)