Our travels now took us to a newly qualified GP, in the first six months of her practice. A brilliant student in her times, a wife and mum to a boy, she juggled family and professional life with great aplomb. Always positive about life, it was always very difficult to get any criticism out of her, unless things were completely unbearable.
After a few brief pleasantries, the conversation shifted to her experience as a new GP and as expected she said that her life could not have been better and finally, she was on course to fulfilling her dream.
The conversation meandered on and after a few pit stops like work-like balance and sharing responsibilities at home it came down to her experience in managing chronic diseases specifically diabetes. It was quite amazing to see her grasp and knowledge of the subject, the thoroughness of her approach and the pains and great effort that she took to give the best possible care for the ones that she was responsible for. We felt extremely reassured and proud of the British medical training and healthcare systems that we are in safe hands. “Then why is it that the National Audit Office is so critical about diabetes management in the UK? And why is it that the problem does not seem to abate?” Then the penny dropped.
It is extremely difficult to put a finger on what the problem is and even more difficult to find what the solution is. All newly diagnosed diabetics are put on a structured education programme and people who have attended it report that this is an excellent programme. But most people don`t attend and “people with jobs simply don`t”. In a climate where jobs are not particularly easy to come by and leave to attend these is discretionary subject to the employer`s altruism, nobody wants to fall behind in the race. There is also a perception of the patient`s apathy, the cause for which is individual and not easy to ascertain. All people who do not attend clinic appointments or miss blood tests are sent reminders and sometimes, she herself pays home visits. “Even then they do not come”. Nobody admits to not taking medicines, but in a lot of cases, test results show otherwise. This creates a bigger problem, because on the one hand there is a suspicion of under dosing, if the person were to be believed and needs dose escalation and on the other hand if the person is not being truthful, any intervention could be disastrous. There is no objective way to decide either way, but the results of both are far from ideal. Unfortunately, this is the norm rather than the exception.
This is a situation that all health care professionals are prepared for and everyone vows to tackle in a different way, but the reality is that what it leads to is despondency and frustration in the healthcare team and thus results are far from optimal. Despite all the healthcare professional`s best possible intentions and efforts, some people don`t bother with anything and are sometimes skeptical and cynical and continue in their merry ways.
A time comes when enough is enough and these people are `lost to the system`, `non-adherent` or simply vanish from attention. Some of them resurface as medical or even surgical emergencies in secondary or tertiary care and their lives are changed for ever.
At these moment, we paused to look at the National Audit Office`s statistics and paused to think, whether there was any solution to what is being termed as apathy or non-adherence. The problems may be extremely individual, something that we are not aware about. We are probably trying to solve a problem, when we do not know what the real reasons are. We do not know what happens between a blood test and an appointment or even a missed one. A 10 minute appointment is grossly inadequate to know someone. A letter from the surgery probably intimidates the person more than helps him or her. And as the vicious cycle of summons and absences continues, maybe we are distancing ourselves from the people we set out to serve. Maybe they are reticent in telling us what their real issues are, maybe they find us too intrusive, maybe a trust deficit and overall.
We are not particularly sure whether the current healthcare set up actually provides a great client experience.
We probably need to take the healthcare to the person, instead of the patient coming to healthcare. It is probably no longer enough to say that the person does not listen. It is time to take responsibility and improve the client experience. Maybe it is time to engage people in their places of comfort, unless it is absolutely necessary to drag them to healthcare facilities. There is no point in having an excellent education programme and people not going to it. More resources are spent in tracing and chasing people than actually treating them. And when everything fails, resources and lives are lost once people have complications and admitted to hospital.
The current budget deficit is clamouring loudly for bringing healthcare closer to people, understanding and managing the person as a whole with emotional support and behavioural intervention along with the present extremely erudite system. What we can do is take responsibility and improve the overall client experience, which motivates patients in such a way that they understand and embrace their problems and lead a life of fulfilment. The best possible way is to give people the opportunity of interacting with healthcare from places where they are comfortable like homes and places of work.