Sunday, 16 January 2011

Reform anxiety – the pandemic we should really fear.

Forget swine flu – the pandemic that is slowly worming its way into the collective consciousness in the UK is a growing sense of nervousness about the NHS shake up.

The BBC appeared to have, at least for now, ceased to be the mouthpiece of the Department of Health, and have just reported that the NHS Confederation feels that some of the changes are ‘extraordinarily risky’

Even the chosen ones – the Royal College of General Practitioners have stated publicly that ‘some government suggestions on providing more choice in the NHS will cause long-term harm to patients and the NHS, particularly for vulnerable adults and at-risk children’

As news coverage seems to echo the fast pace of these reforms, anxiety is increasing in parallel.

I have experienced reform anxiety first hand, working on projects with NHS staff across the patient pathway. Most of those ‘embedded’ in the NHS are nervous about their jobs, their future, patient care, their organisation or department and without exception, the pace of the changes.

This anxiety and concern is natural – many of us don’t really like change, especially if we feel it’s out of our control. But the effect of this uncertainty on patients had escaped me until today and I thought I would share this story with you.

A friend if mine is a fit, healthy young woman. She is intelligent and confident, and very rarely needs to see a doctor. Earlier today the symptoms of what appeared to be a chest infection suddenly became much worse and started to cause her severe pain when coughing. So she called her GP practice out of hours service and was very pleased to get an appointment to see the emergency doctor at a nearby clinic. When she walked into the consulting room, the conversation with this GP was virtually verbatim as follows:

GP: ‘So what do you think is wrong with you?’
Patient: ‘I think I have a chest infection’ – she then described her symptoms
GP:’’Do you have a temperature?’
Patient: ‘I feel very hot but I don’t have a thermometer so I don’t know’
GP then takes her temperature and listens to her chest with a stethoscope
GP: ‘Your chest sounds clear’.
Patient: ‘It hurts when I breathe and I have a painful hacking cough and I have felt ill for nearly two weeks’
GP: ‘So you think you have a chest infection?’
Patient: ‘I rather hoped you might be able to tell me the answer to that’
GP:’ What would you like me to do about it?’
Patient: ‘Again – I thought that was for you to decide – I’m not medically trained.’
GP: ‘Would you like some antibiotics?’
Patient; ‘If you think that’s a good idea’
GP: ‘I’ll give you a prescription and then you can decide whether to take them or not’

I won’t presume to comment on the doctor’s bedside manner (especially as his parting shot to my friend was – ‘perhaps you shouldn’t be quite so quick to see a doctor next time’). And I know that there are thousands of excellent GPS currently practising in the UK. But what shocked me is what happened next.

My friend called me and asked me if that was the way it now had to be in the NHS – ‘do patients really have to decide their own treatment’? She has read so much in the press about patient power that she genuinely believed that this GP’s crass behaviour was going to be the norm

Andrew Lansley, the UK Secretary of State for Health says that the NHS reform will result in ‘the power in the hand of the patient and their GP’

Has it occurred to him that every time he uses that statement – he actually undermines public confidence in the professionals in whom we have been trusting our lives?

I would like to say something soothing and reassuring to any potential patients who may be reading this.

But I don’t think I can.


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