It was great to see Keith start this blog. Conversation should be open, clear and transparent. As you will see from my comments on his first few posts, I'm not sure that talking about a new model of health or medicine helps at this stage. We do seem to be moving along a continuum, rather than about to experience a paradigm shift. For that reason I am more interested in talking about what is good or bad about our current situation and how we could make it better. Maybe I am too much of a pragmatist to really be an academic theorist!
Back in 2001 I was working for 6 months in public health in Avon Health Authority in Bristol. I came across a really interesting book by Muir Gray, called the Resourcesful Patient, that was available free online. He suggested that much of the authority of doctors was now passing, and that patient would and shoud have a much greater role in determining their own health care choices. Unfortunately the book is no longer freely available online- I'm not sure why- but it means that I may be getting aspects of it wrong so I will not say much more about it! (EDIT: Thanks to a reader who has directed me to this archive of the Resourceful Patient. Read and enjoy)There are some good reviews of the book around including this one by Peter Toon. In it Peter, says that although technology and the internet will allow patients to have greater access to information about their health, and will to a certain degree level the interactions between doctor and patient, many patients, particularly those from poorer backgrounds, who have had less access to education, may get left behind.
This is a big concern to me. I work in the South Wales valleys. Funding for my first post here was initially provided by the Welsh Assembly Government to try and increase academic links between GP practices in the valleys and Cardiff University, so that both could learn from each other. Julian Tudor Hart, a GP from South Wales, first described the Inverse Care Law in 1971, whereby those people who have most need for healthcare have least access to it. One would think that the NHS should be evening things out and ensuring that those who need treatment, get it. But things are not as good as they should be.
GPs in poorer areas refer less patients to secondary care, and for possibly less serious conditions like dermatology and allergies the differentials seem to be even higher. But it is worrying that in inner city London if you are identified as having cardiovascular disease you have a 1:43 chance of dying, whilst in the leafy suburbs that chance is 1:124. So is this just because GPs in poorer areas are not such good doctors and are not working hard enough? The Care Quality Commission (CQC) thinks that GPs need more incentives to make them sort this problem out. But those who have been working in Primary Care Trusts in England trying to tackle health inequalities know that the problem is more complicated than this. If you read the strategies that they are taking about to try and improve health for the most needy populations, particularly the words of David Regan, from Manchester, you will see that empowering patients means helping patients to know about the symptoms of illness that they should be looking our for, and working with local communities. Beyond that it means improving education and reducing unemployment.
People used to ask if I was bothered by patients printing of information from the internet and bringing it to a consultation. I most certainly am not. These patients are taking advantages of the technologies available to them to empower themselves. I worry about the fact that not more of my patients do this. This is our challenge.