Are We Going Around In Circles?

I was having induction at my new Family Practice a month ago.  This was so I understood how the practice worked before I started seeing my patients on my own.

Insanely insightful seeing all these patients go on their journey after being seen by the doctor.  Doctors have to collect data and trial a lot of treatments.  We might send you to have some blood tests, have physiotherapy, go for a scan etc etc.

What struck me though was that most patients don’t have a clue about what’s going on.

For example, I was sat in with the healthcare assistant (HCA) one morning as she gave patients their injections and took blood samples the doctors had ordered.

“Why are you having these blood tests done?” the HCA asked.

“To be honest I don’t know.  The doctor said something about vitamins, but I’m really confused.” the patient responded.

That seemed to be the theme of the whole morning.

GPs (Family doctors) have ten minutes to see each patient in England.  We are taught during our GP training that 4 of those minutes should be used to explain the patients diagnosis and create a shared management plan.

Now believe it or not, I think for most things 4 minutes is enough!  If you had, say high cholesterol, which required taking medication, I think I could explain the basics in 4 minutes.

Whether you’d absorb all of that knowledge however is a different matter.  And actually, understanding all the intricacies  that go into cholesterol metabolism and how it affects you and why medications help, what role statistics play (numbers needed to treat etc.) in starting treatment, why we need to monitor your blood test results and what we’re looking out for……well that requires in depth study.

We are often told about patient empowerment and how patients should be taking control of their illnesses.  This is obviously great and a lot of patients with certain conditions do indeed understand their condition better than their physician.

However, for most patients it seems like medicine is still very paternalistic and in their cases it’s probably a good thing!  It seems that most people simply don’t understand or don’t want to understand and take control of their own conditions.

This is ironic as most of the major illnesses today are due to lifestyle factors and patients not taking responsibility of their health in the first place.

Are we going around in circles here?  Should I as a physician care?  And what am I meant to do to help these patients?

Needless to say I left my morning induction more dazed and confused than pretty much any other day I’ve been a doctor!


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