How can I empower other patients?

It's been sometime since I did anything to develop the model I presented in my first post in this blog. The most recent post is presented as an account of an actual consultation and how it left the patient (and her supporter) feeling. It is thus part of the body of evidence I am drawing on.

Anne Marie and I have had a vigorous private debate over on Wave which had two components:

1. I was trying to use my own experiences within the NHS to demonstrate that medicine used to be much more paternalistic  than it is now but that it is not yet where we would want it to be.
2. We were to trying to understand where each other is coming from and how that affects the way we regard medical practice.

Anne Marie concluded that I am effectively an engineer and thus look for clear cut solutions. I am also sightly older than the NHS so my initial impression of medical practice were more "old-school" than Anne Marie's; what's more she is an educator and thus pretty much at the leading edge of establishing best practice in modern medicine.

I need to explain the philosophy behind defining the kinds of models that I have been using. The techniques come from my background in Business Analysis and are meant as tools to understand where an organisation has come from, where it wants to be sometime in the future and where it is now. It is then possible to articulate a set of well constructed goals and objectives, projects etc... that will move the organisation towards the desired end point. This is a purely intellectual process; the skill comes in communicating the strategy to the people who are going to be affected by and effecting the change. More often than not in the commercial world this where management fails (The Post Office and British Airways are probably cases in point.)

I hope that Anne Marie and I agree that medicine is more collaborative than it used to be but not as collaborative  as we would like. Anne Maria is doing her bit to educate new practitioners t work more closely with the people they see and help them manage their health. However, there are risks that this model will not be universally applied nor accessed by all people who need it.  South Wales in particular has a significantly large group of people who are disadvantaged by generational unemployment, poor education and digital poverty (lack of access to high speed internet connection and the ability to find and evaluate information about their health needs and opportunities).

So I've decided that rather than faff about trying to define a Nirvana I simply need to help build it. There is sufficient consensus of what the future should be amongst "forward-thinkers" that we should get on and do.

So Anne Marie, what can I do to help the patients in your GP practice to become better empowered?

Why we need empowered patients- a GP perspective.

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.