Heroes Not Zombies

BBC news reports today that Loyd Grossman has attacked government for failing to take patients’ nutrition seriously. In response, the Department of Health “spokesperson” (why are these people always anonymous?) says

A Department of Health spokesperson said: “Hospital food has improved greatly over the past few years.

Wow! It has??!! Well I work in an NHS hospital and I can’t say I’ve seen any improvement in hospital food, so that got me wondering…….improved how? What has improved? The food has improved? I popped across to the Audit Scotland site and found a report on catering in NHS hospitals in Scotland dated last November.

They found that NHS spending on food and beverages (that’s not the catering costs including staff pay and so on, it’s just the cost of the food and beverages) rose from £2.23 per person per day in 2001/2002 to £2.34 in 2005/2006 (and they point out that’s less than the rate of inflation over that period) But that’s an average! The hospital where I work actually spends less than two pounds per patient per day on food and beverages. (about £1.60 actually)

OK, so it’s not rocket science, but what do you reckon? You think the DOH spokesperson is right? The food has improved “greatly” in recent years but they’re actually spending less on it?

How can we expect sick people to get better if we don’t feed them well? Surely a sick person needs even better nutrition than a healthy person does? Here’s my question to anyone in the DOH “What’s your daily spend on food and beverages for your family?” Then compare that to what a hospital patient is given and ask yourself if there’s a problem here.

….that might seem like a strange and obvious statement, but the reality is that health is experienced by individuals which is why we need a health service which is patient centred, taking a holistic focus to understand the differences between people as well as their similarities (what diseases they have). However, the other side of the partnership in healing is the health care professional – doctors, nurses and other professionals. There’s a strange distortion of “Evidence Based Medicine” which seeks to reduce the whole of health care to numbers, as if people don’t matter. We see this in the way that randomised controlled trials are conducted using methods which explicitly seek to exclude the individual people effects – you never see any mention in a research paper of who the individual health care professionals were who actually interacted with the nameless and faceless patients in the trial. It’s as if we can only rely on studies which exclude the effects and contexts of human beings. This has always struck me as strange.

In any GP partnership, patients quickly suss out which doctor is good for which approach. Those who want to be given time to talk about their problems seek out the doctor who listens. Those who want antibiotics seek out the one who is best known for prescribing them without lectures…….and so on.

Doctors are not clones. They are individuals too. In good health care each of us needs to find a doctor we can connect with, one who is on our wavelength. Yes, we want a surgeon, a physician, a GP who has good up to date technical knowledge and skill. That’s a given. But we need more than that. We need a good human relationship with him or her.

So, I wholeheartedly endorse Dr Everington of the BMA today who says

Doctors feel under attack, the government wants to turn everything into something that has just a monetary value. Vocation, dedication and lifetime commitment to patients and the NHS has little value in this new world – we are just financial commodities.

There’s a process going on in the NHS known as “Agenda for Change“. It’s central tenet seems to be that every job in the NHS can be described according to the knowledge and skills required to do that job, every person can have their knowledge and skill level assessed, then anyone with the requisite level for a particular job can do that job. The actual human beings become dispensible and interchangeable. The whole process is demoralising for thousands of NHS staff. People matter. Personal, individual qualities and characteristics matter. Two different people doing the same job will interact with people differently. In health care this matters. In a factory making widgets it maybe doesn’t. But GP surgeries and hospitals are not factories and people are not widgets.

A study published in The Archives of Internal Medicine looked at how doctors greet their patients. In particular they studied how often doctors used the patient’s name and how often they greeted the patient with a handshake. They claimed to show that most patients wanted to be greeted by name and with a handshake and that many times doctors failed to use the patient’s name. However, the statistics on the handshaking are fascinating –

Seventy-eight percent of patients surveyed wanted a doctor to shake their hands, while 18 percent did not. In the taped sessions, doctors and patients shook hands 83 percent of the time.

Read that carefully. 78% of patients said they wanted the doctor to shake their hands. 83% of time the doctor shook the patients hand. What does this mean? That doctors are shaking patients’ hands too readily? That more patients get their hands shaken than wish to do so? Funnily enough, there’s no comment about this strange anomaly.