A lot of work has been done in recent years to ensure we consider the patient perspective. Over the years at the BJGP I have noted that one perennial favourite for opinion articles is the ‘doctor as patient’ genre. Doctors write to us and tell us about the intimate details of their illnesses and their sudden traumatic wrench to the viewpoint of a patient. The accounts are often moving and frequently insightful. Almost always, the experience of being a patient seems to come as a terrible, atrocious surprise. Let’s linger on that. The experience of being a patient comes as an appalling shock. To doctors.
This needs some unpacking. It could be that we are observing a reporting bias and most doctors fully appreciate the vicissitudes of being ill and being processed, as a vulnerable widget, in the healthcare system’s machinery, a system striving for ever more efficiency (or profit). We can blame the system but surely doctors should still have a better appreciation than anyone? These plaintive articles lead one to an uncomfortable conclusion that is, arguably, rather alarming, if not damning of the medical profession.
There is evidence, if indirect, to support this. The concept of ethical erosion has been defined as being ‘where empathy and sympathy decline with increasing clinical experience’.1 It has been a source of concern in medical education for many years. What is happening that we turn students and trainees away from people? One proposed solution, close to the hearts of GPs, is that greater continuity in medical education could help ameliorate this, and novel models such as the longitudinal integrated clerkship offer a remedy.2 In these, students meet and follow patients from their first contact in primary care and then stick with that patient on their own journey through into the machinery. It seems simple and obvious but the logistics are formidable and it requires a radical restructuring of undergraduate education.
In health care, we have allowed the patient and the person to be separated, artificially hived off from one another. In its worst form it’s the ‘gallbladder in bed three’ and the ‘off-legs in bed four’ but it is rarely as blatant as that nowadays — the problems are more subtle though no less pernicious. It’s a modern medical dualism: the ghost in the machine is the person in the healthcare system. It is not a new observation that we face multiple challenges with integrating the patient perspective, not least the problem of tokenism when there are systemic biases. The best of general practice often strives to overcome this dualism but it haunts many of our interactions with patients who feel unseen and unheard.
| This month several papers lean into the patient perspective, especially the editorial on coeliac disease diagnosis and the accompanying research article by Harper and colleagues. The editorial by Polak and Etkind challenges us to think how we might ‘level up’ palliative care and we also have research on patient views on identification of palliative care needs. Willie Hamilton offers a lucid appraisal of the challenges of diagnosing leukaemia. Research includes articles on antidepressant cessation, the new GP contract in Scotland, and remote consultations. And articles on managing pain syndromes in Parkinson’s, asymmetrical tonsils, and the management of asthma will guide clinical practice. |
- © British Journal of General Practice 2024
