Professor David Haslam, chairman of the National Institute of Health and Care Excellence (NICE), says in an interview with the Daily Telegraph, that patients should be more pro-active about their health and 'pushier' with their GPs. How realistic is his view, and where does our responsibility towards ourselves as patients start and that of a medical professional end?
While Prof Haslam has started an interesting and important debate, I urge caution regards the conclusions we draw. All will not be well, if only we took more responsibility.
Having worked in the NHS myself, I am aware of the time-poor and highly pressurized service delivery environment and its impact on patients and staff alike.
Professionally I specialize in working with people affected by cancer. How to find the motivation and determination to be actively involved in health choices during and after treatment is often a central theme.
Having been treated for cancer myself I have experienced at close quarters the intense struggle patients can find themselves in: searching for answers, wanting to find out more about medical and perhaps complementary or alternative therapies, sometimes feeling too sick or demoralized to do anything, finding it difficult to trust treatment suggestions (esp if your life depends on it), not being listened to, being reduced to the illness we have and not the person we are or being blocked by appointment times.
Prof Haslam states that patients had a "legal right" to medicines once they had been endorsed. According to the BBC, the NHS faced criticism last week over figures apparently suggesting certain drugs were not being used, despite being given the green light from Nice.
While I agree with his view that patients should be proactive about their health, better informed and encouraged to request medication they are entitled to, surely GPs have duty of care to us to prescribe the most appropriate medication. Surely, we should be able to trust their judgment, without having to research, what medication is most suitable. Not all of us are capable of such an undertaking or confident to have such a conversation with our GP, especially when our medical (and often life-changing or life-shortening) conditions can leave us feeling exhausted, overwhelmed, frightened and depressed.
He encourages a relationship of equals in the consulting room, as "it is essential for the future of the health service and for the future health of the nation". I could not agree more. But this is a shared responsibility, which health care professionals need to take to heart.
Only the other day, when asking for a Vitamin D test, I found myself having to defend my request against the argument that 'the lab will not pay for another test, your last one was in March'. I had done my research, was trying to be proactive and responsible. I regard myself as fairly articulate and pleasant to talk with, yet was told that my GP in no uncertain terms that he was unwilling 'to have this debate' with me. The lack of eye contact on his part did not help matters. In the end, he put in the request, clearly stating it will be up to the lab (not him) whether the test gets done. While there is often one good example for every less helpful one, I was left frustrated and worried where I stand, if I should need my NHS GP Surgery again for more serious health issues.
Having a constructive and safe working relationship with a health care professional, like a GP, requires continuity. We do not get that with the current appointment system. Even when I received cancer treatment as an outpatient, I rarely had a single or continuous point of contact for my medical questions, which often centered on the damaging side effects of medication I was prescribed to help with chemo side effects. In the end I refused to take the medication and sought alternative assistance outside the NHS, which I had to fund myself.
While I welcome the debate about shared responsibility and firmly believe in the mental and other health benefits of finding the inner strength and determination to be actively involved in one's treatment and health choices, it is not always as black and white as that.
I believe we are entitled to and should be able to trust and rely on a final and trusted fall back, our GP.
Psychotherapist & Counsellor
BA (Hons), MA (Couns.Psych.), Reg. MBACP (Accred)