There’s a lot of talk around just now about “patient centred care”. It’s one of those concepts that nobody argues against. In fact, pretty much everyone claims to be doing it. If that’s true, then it must mean different things to different people. Or it must have so many aspects, that different people resonate with the concept because they understand and value one of those aspects.
There’s a vast and growing literature on “patient centred care” but I’d like to make a contribution to the debate. I’m writing here from the perspective of a generalist, holistic, integrative doctor. I work at the “NHS Centre for Integrative Care” which, we claim, is a patient centred service within the NHS.
Some health care services are disease centred. There are Diabetic Clinics, Asthma Clinics, Hypertension Clinics and so on. These are specialist services where only people with particular diseases are seen, and where progress is measured primarily by measuring changes in the disease activity.
Some services are therapy centred. When you attend one of those services, only particular therapies will be used, no matter what your diagnosis, or who you are. The two biggies are surgery and drugs. Most services are designed to support the delivery of one of those two therapies. “CAM” (“complementary and alternative medicine”) clinics are often therapy centred too. Acupuncture Clinics, Osteopathic Clinics, Homeopathic Clinics etc. When you go to one of those you will see someone who has specialised in that particular therapy, and they will try to help you using that therapy.
Integrative Care is a patient centred therapy. It delivers individualised, multidisciplinary care using a range of different therapies, based on a holistic, personalised understanding of the individual patient. It is generalist, in that it is not limited to patients with specific diseases, and it is integrated in that it is not limited to the use of one particular therapy.
Now, I’m sure, there are many who will explain why their disease-centred, or therapy-centred service is also patient-centred, but I hope it’s helpful to clarify why an “integrative care” service cannot be defined by either the therapies used, or the disease diagnoses of the patients attending.
A wonderful service and an ideal goal for many but how do you educate, or reeducate, Health Care professionals? Do they need to alter the all too easy but ingrained singulist approaches? Surely the holistic approach demands a wider education and understanding and dare I say dedication to the ‘whole’. In this current climate of trimming everything down to the bare minimum how can education/training change the system and personnel in healthcare for all patients?
How do you educate the staff and students in the Centre for Integrative Care and how do you attract staff with this perspective?
This should be the goal in healthcare but I am exhausted thinking of implementation at this time!
I’m sure your focus on education and training is a good one and should be a priority. And, yes, it isn’t easy, especially when the reductionist, mechanistic philosophy is still so dominant in health care and there is such a focus on cutting spending. However, there are some green shoots…..
We’ve created a charity, The Vital Force, which has education and training as one of its aims (early days, but it’s beginning). Check into http://www.thevitalforce.org/ to see.
We’ve also created a Clinical Fellowship in Integrative Medicine, and have a young doctor one year into that program (hopefully we can raise funds to deliver this for other doctors in the future)
This summer we had a visit from the Health Minister in Scotland and he urged us to create integrative medicine training and education for healthcare professionals.
At a scientific level, discoveries in neurobiology, developments in systems thinking, the holistic frameworks of complexity science, especially “complex adaptive systems” are all contributing to the potential for a new direction in healthcare education and training.
As you can tell…..I’m an optimist!
Inspiring and the optimism shows! The Vital Force looks great and joinable! “Rock on” as they say!! This is very encouraging to those of us who feel out on a fringe but keep working away.