The more you understand and help manage your own health care the better. There is good evidence that better involvement results in highly significant reductions in adverse events. The NHS is promoting this wholeheartedly as it also has massive potential for efficiency savings. It never was the case that medical care was best left to the professionals who knew the definitive answers. Doctors report higher satisfaction from consultations where the patient is more able to engage in discussing the management of their situation.
The Health Foundations co-creating health project is finding that people get better quality of life by taking a more active role in their own health care. There are many ways in which the therapeutic relationship can be strengthened and this is the task of a health consultant. Enabling health is far more than simply controlling illnesses; it does require an investment of time and resources, but the evidence that this is worthwhile is overwhelming. The NHS is encouraging patients to co-create health; to take action to enhance their own health alongside the medical care they receive. With the shifting demographics and increasing medical needs it is in fact more a necessity than a nicety, that we are all proactive in enhancing our health.
Friday, 30 March 2012
Wednesday, 22 February 2012
In support of NHS General Practice
"Jack of all trades, master of none,
Certainly better than a master of one"
To argue whether a generalist is more valuable than a specialist is to miss the point that each has their place. Such polymaths as Leonardo da Vinci, who had skills spanning the arts and science, lived in an age of liberalising Renaissance thought, which viewed people as having limitless capabilities. Such a notion nurtured enablement of individuals to develop themselves and avoid the limitations often imposed by an oppressive body of conservative opinion.
Within the sphere of health the debate about specialism is further complicated by the notion that the body cannot be considered as a machine to be divided into different functions, but has to be considered as a whole. In this respect specialisms that deal with only one aspect of bodily function are to an extent arbitrary distinctions; it can be viewed that such a divisive process can undermine natural homeostatic mechanisms. Far more persuasive however, is the fact that critical actions are often necessary and this should be performed efficiently by a professional whose skill in the specific task is developed as fully as possible. The generalist is well-placed to apply the knowledge they have, to know when this is not sufficient and refer to an appropriate specialist when needed.
There is an increasing realisation that as a nation our capabilities to provide therapies outstrips our ability to pay for them within the NHS. This is an uncomfortable truth to politicians whose interests lie in promoting the perception that limitless care can be provided. It is also uncomfortable as a GP, as the consideration of resources impinges more and more upon the therapeutic relationship. The role as patient advocate is increasingly balanced (to be frank) with the desire to make financial savings and indirectly boost the personal share of business profit.
To conclude there is an ever increasing value to an independent advocate, who is able to engage alongside (and also think beyond) the limitations of conventional medical care. Who can enable sound decision making, have more time to provide holistic care and draw on knowledge of an expanded range of evidence-based therapies; enter the Health Consultant.
Certainly better than a master of one"
To argue whether a generalist is more valuable than a specialist is to miss the point that each has their place. Such polymaths as Leonardo da Vinci, who had skills spanning the arts and science, lived in an age of liberalising Renaissance thought, which viewed people as having limitless capabilities. Such a notion nurtured enablement of individuals to develop themselves and avoid the limitations often imposed by an oppressive body of conservative opinion.
Within the sphere of health the debate about specialism is further complicated by the notion that the body cannot be considered as a machine to be divided into different functions, but has to be considered as a whole. In this respect specialisms that deal with only one aspect of bodily function are to an extent arbitrary distinctions; it can be viewed that such a divisive process can undermine natural homeostatic mechanisms. Far more persuasive however, is the fact that critical actions are often necessary and this should be performed efficiently by a professional whose skill in the specific task is developed as fully as possible. The generalist is well-placed to apply the knowledge they have, to know when this is not sufficient and refer to an appropriate specialist when needed.
There is an increasing realisation that as a nation our capabilities to provide therapies outstrips our ability to pay for them within the NHS. This is an uncomfortable truth to politicians whose interests lie in promoting the perception that limitless care can be provided. It is also uncomfortable as a GP, as the consideration of resources impinges more and more upon the therapeutic relationship. The role as patient advocate is increasingly balanced (to be frank) with the desire to make financial savings and indirectly boost the personal share of business profit.
To conclude there is an ever increasing value to an independent advocate, who is able to engage alongside (and also think beyond) the limitations of conventional medical care. Who can enable sound decision making, have more time to provide holistic care and draw on knowledge of an expanded range of evidence-based therapies; enter the Health Consultant.
Thursday, 17 November 2011
Listening
If the person you are talking to doesn't appear to be listening, be patient. It may simply be that he has a small piece of fluff in his ear.
-- Pooh's Little Instruction Book, inspired by A. A. Milne
..... or it may simply be that they're caught up in feeding the machine on their desk or the gadget in their paws. When there are so many signals competing for our attention, multi-tasking could appear to be the solution. However, the findings of studies into multi-tasking are pretty negative.
Multitasking: “mythical activity in which people believe they can perform two or more tasks simultaneously as effectively as one.” (Edward Hallowell)
In the therapeutic relationship listening is a fundamental consultation skill for the therapist. What about the client though? As you consider this listening, you will really begin to hear more complete messages coming back. How consistent is it with the message you are sending? You should feel reassured that there is an understanding. What you do to improve this understanding will depend on the situation, but there is certainly some wisdom in Pooh's advice.
-- Pooh's Little Instruction Book, inspired by A. A. Milne
..... or it may simply be that they're caught up in feeding the machine on their desk or the gadget in their paws. When there are so many signals competing for our attention, multi-tasking could appear to be the solution. However, the findings of studies into multi-tasking are pretty negative.
Multitasking: “mythical activity in which people believe they can perform two or more tasks simultaneously as effectively as one.” (Edward Hallowell)
In the therapeutic relationship listening is a fundamental consultation skill for the therapist. What about the client though? As you consider this listening, you will really begin to hear more complete messages coming back. How consistent is it with the message you are sending? You should feel reassured that there is an understanding. What you do to improve this understanding will depend on the situation, but there is certainly some wisdom in Pooh's advice.
Wednesday, 14 September 2011
The Modern Expert Generalist
"The modern expert is someone who knows how to access knowledge efficiently and judiciously and who can form conceptual links between seemingly unrelated areas."
This quote comes from a series of articles about Complexity science in the BMJ back in 2001. It would support the idea of the generalist. Rather than using the brain as a store of information, it can be liberated to consider multiple dimensions and to understand at a deeper level. Did Einstein really decline to memorise his phone number?
A generalist is able to consider a wider spectrum of information, mulling this in the mind with great care and allowing solutions to emerge with the client.
As you consider whether to use pharmaceuticals, acupuncture, homeopathy, CBT, NLP, mindfulness, you will realise that they may all offer something to a certain extent and there will be other approaches you hadn't considered. Gaining a greater understanding is a powerful healer; a Health Consultant can draw on knowledge of a range of therapeutic avenues offering great flexibility; many concepts will simultaneously be operating within the process. The individual practitioner will recognise their own strengths and be able to refer to appropriate specialists.
You really can now trust yourself to actualise your better future right now; you can see the importance of being the best person that you can be.
This quote comes from a series of articles about Complexity science in the BMJ back in 2001. It would support the idea of the generalist. Rather than using the brain as a store of information, it can be liberated to consider multiple dimensions and to understand at a deeper level. Did Einstein really decline to memorise his phone number?
A generalist is able to consider a wider spectrum of information, mulling this in the mind with great care and allowing solutions to emerge with the client.
As you consider whether to use pharmaceuticals, acupuncture, homeopathy, CBT, NLP, mindfulness, you will realise that they may all offer something to a certain extent and there will be other approaches you hadn't considered. Gaining a greater understanding is a powerful healer; a Health Consultant can draw on knowledge of a range of therapeutic avenues offering great flexibility; many concepts will simultaneously be operating within the process. The individual practitioner will recognise their own strengths and be able to refer to appropriate specialists.
You really can now trust yourself to actualise your better future right now; you can see the importance of being the best person that you can be.
Wednesday, 3 August 2011
Positive Regard
This blog entry brings together previous posts to clarify some of the points raised. Let's start with the statement that a Health Consultant does not treat illness. This means that the client is left free to give as much or as little information as they wish. There will be solutions that are tailored to the person rather than their illness. This is no radical idea:
“The good physician treats the disease; the great physician treats the patient who has the disease”
"Don't tell me what type of disease the patient has, tell me what type of patient has the disease"
Dr William Osler (1849 – 1919)
However, such a focus can more easily be held when the confounding concerns of medico-legal responsibilities are diminished; this has a liberating effect on the therapeutic relationship and opens new avenues.
If the client chooses to give only a little information then the health consultant should listen carefully, be willing to do the best they can and suggest a strategy for enabling health. You will not be burdened with having to go through the whole story all over again. If we touch on issues that you find difficult, the Health Consultant will make it very easy for you to shift the process and the positive regard towards the client would not in any way change.
Please excuse me as I end this short entry by wishing you a very fulfilling summertime.
“The good physician treats the disease; the great physician treats the patient who has the disease”
"Don't tell me what type of disease the patient has, tell me what type of patient has the disease"
Dr William Osler (1849 – 1919)
However, such a focus can more easily be held when the confounding concerns of medico-legal responsibilities are diminished; this has a liberating effect on the therapeutic relationship and opens new avenues.
If the client chooses to give only a little information then the health consultant should listen carefully, be willing to do the best they can and suggest a strategy for enabling health. You will not be burdened with having to go through the whole story all over again. If we touch on issues that you find difficult, the Health Consultant will make it very easy for you to shift the process and the positive regard towards the client would not in any way change.
Please excuse me as I end this short entry by wishing you a very fulfilling summertime.
Friday, 22 July 2011
Rocking Gently
From The Guardian 19th July 2011:
"Healthier behaviour plans are nudge in the wrong direction, say peers: House of Lords committee criticises attempts to curb junk food and alcohol consumption through voluntary agreements"
This article relates to a House of Lords science and technology committee report which questioned ministers use of what is known as the nudge theory.
Nudge theory is described in the book by Thaler and Sunstein entitled "Nudge: Improving decisions about health, wealth and happiness". Nudge theory advocates influencing behaviour by altering the context or environment in which people choose.
Here are a couple of quotes from the book:
"Nudges count as such and qualify as libertarian paternalism only if any costs are low"
"By properly deploying both incentives and nudges, we can improve our ability to improve peoples lives"
Nudge theory is relevant to social policy; it is not a tool to be used at the individual level. For instance, to pry into peoples personal habits is not a nudge, it's a poke in the ribs and a health consultant should not do it.
Infact, often people find themselves tossed precariously on stormy waters; a little nudge from government in such a situation is not going to have much influence. In such a situation, the Health Consultant would wish to support and assist you until you feel yourself rocking gently on those waves.
Stevie Smith - Not Waving But Drowning
Nobody heard him, the dead man,
But still he lay moaning:
I was much further out than you thought
And not waving but drowning.
Poor chap, he always loved larking
And now he's dead
It must have been too cold for him his heart gave way,
They said.
Oh, no no no, it was too cold always
(Still the dead one lay moaning)
I was much too far out all my life
And not waving but drowning.
"Healthier behaviour plans are nudge in the wrong direction, say peers: House of Lords committee criticises attempts to curb junk food and alcohol consumption through voluntary agreements"
This article relates to a House of Lords science and technology committee report which questioned ministers use of what is known as the nudge theory.
Nudge theory is described in the book by Thaler and Sunstein entitled "Nudge: Improving decisions about health, wealth and happiness". Nudge theory advocates influencing behaviour by altering the context or environment in which people choose.
Here are a couple of quotes from the book:
"Nudges count as such and qualify as libertarian paternalism only if any costs are low"
"By properly deploying both incentives and nudges, we can improve our ability to improve peoples lives"
Nudge theory is relevant to social policy; it is not a tool to be used at the individual level. For instance, to pry into peoples personal habits is not a nudge, it's a poke in the ribs and a health consultant should not do it.
Infact, often people find themselves tossed precariously on stormy waters; a little nudge from government in such a situation is not going to have much influence. In such a situation, the Health Consultant would wish to support and assist you until you feel yourself rocking gently on those waves.
Stevie Smith - Not Waving But Drowning
Nobody heard him, the dead man,
But still he lay moaning:
I was much further out than you thought
And not waving but drowning.
Poor chap, he always loved larking
And now he's dead
It must have been too cold for him his heart gave way,
They said.
Oh, no no no, it was too cold always
(Still the dead one lay moaning)
I was much too far out all my life
And not waving but drowning.
Friday, 15 July 2011
Making Headway
Ending the stalemate over CFS/ME
Fiona Godlee
BMJ 2011;342:doi:10.1136/bmj.d3956 (Published 22 June 2011)
The very term CFS/ME indicates the separation and disagreement that exists over this condition. It seems a sensible approach not to argue over terminology, whether it's CFS or ME, and use the term CFS/ME. Diagnostic classifications, causation and treatments are all still hotly disputed. What would the Health Consultants position be?
The Health Consultant does not treat illness. Really?
Enhancing health is quite distinct from treating illness. Illness and its multitude consequences will inevitably drain health and vitality and it is the role of the Health Consultant to help restore this. If you were looking for somebody to execute a cure to your illness you would need to look elsewhere.
The Health Consultant helps the person; a constructive approach to enabling health would be possible without the client even mentioning any diagnostic labels. Such labels result in certain judgements being made; not always a bad thing if information is properly deliberated to avoid it being misjudged.
When working with the Health Consultant it should be apparent to you that you are engaged in a confidential dialogue, that is open-minded, impartial and focused on positive outcomes.
Fiona Godlee
BMJ 2011;342:doi:10.1136/bmj.d3956 (Published 22 June 2011)
The very term CFS/ME indicates the separation and disagreement that exists over this condition. It seems a sensible approach not to argue over terminology, whether it's CFS or ME, and use the term CFS/ME. Diagnostic classifications, causation and treatments are all still hotly disputed. What would the Health Consultants position be?
The Health Consultant does not treat illness. Really?
Enhancing health is quite distinct from treating illness. Illness and its multitude consequences will inevitably drain health and vitality and it is the role of the Health Consultant to help restore this. If you were looking for somebody to execute a cure to your illness you would need to look elsewhere.
The Health Consultant helps the person; a constructive approach to enabling health would be possible without the client even mentioning any diagnostic labels. Such labels result in certain judgements being made; not always a bad thing if information is properly deliberated to avoid it being misjudged.
When working with the Health Consultant it should be apparent to you that you are engaged in a confidential dialogue, that is open-minded, impartial and focused on positive outcomes.
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