A GP In Despair: We've Got Some Medicine, Where's The Care?

I have recommended Dr. Crippens's NHS Blog Doc on several occasions. It is, by turns, a funny, provocative, gut-wrenching insight into what it is like for GPs who are attempting to provide decent medical care within the NHS. The recent entries are gut-wrenching, plain and simple (hint, you will need to look at the comments and read about what happened on Friday morning to grasp even an iota of the anger and despair underlying this post).

Dr. Crippen has written about the lack of availability of basic nursing care (such as the debridement and care of bedsores) on many occasions. He has painfully detailed times when his own judgment and knowledge of his patients was over-ruled by the application of a protocol by someone who does not know his patient (most notably: the incident of the aneurysm and the paramedics; and the difficulty in admitting a patient whom he had assessed as suicidally depressed - Friday's entry). Dr. Crippen has the medical knowledge and (very obviously) a sense of care that is only found in those who are dedicated to their vocation. It seems as if, very regularly, he is frustrated from exercising both of those qualities.

All of my recent reading about allostasis has emphasised that medical innovations have had an extraordinary impact on our quality of life, well-being and longevity. However, in his essay in Allostasis, Homeostasis, and the Costs of Physiological Adaptation, Sterling argues that these extraordinary, high-level medical interventions are being delivered in a low-level, mechanistic way. He argues that these interventions are most successful when they are delivered in the rounded context of care that address all a person's needs - which probably encompass basic nursing needs, and the comfort of human contact.

When it literally costs an arm and a leg...

We spend so much money fire-fighting acute issues that there is little money or political will available for prevention programmes. I’ve been thinking about this in the light of my own experiences and those recently reported by Jamie Wallace and his Walkit project. The issues are common to the people in the projects that I mentioned yesterday.

The economics of prevention versus cure has been starkly highlighted in an excellent series of articles about the New York experience of diabetes in the New York Times (it’s a registration/subscription site so there is little point in providing the links). 1 in 8 adult New Yorkers now has Type 2 diabetes, with the incidence rising to 1 in 5 in some neighbourhoods and for some demographics (like the over-65s). Diabetes exacts a vicious psychological and physical toll on many people and has an extraordinary impact on their quality of life. An estimated 800,00 New Yorkers have diabetes, yet the New York Public Health Authority has a staff of 3 and a budget of 950,000 dollars to address the spread of the disease.

With such different models of health-care funding, it’s remarkable that health-care in the UK has many of the funding issues that Health Maintenance Organizations have in the US but for different reasons. 7 years ago, in New York, hospitals opened 4 innovative diabetes centres that were meant to function as boot camps for diabetics. The centres taught diabetics to monitor their blood sugar, watch their food intake and exercise while under-going intensive monitoring from a multi-disciplinary team. The centres were successful in their education programmes. The Beth Israel Center was so effective that five months into their project, more than 60 per cent of the tested patients had their blood sugar under control. And almost half of the tracked patients had lost weight.

Making Harlow Happy

I live in Harlow. Recently there has been a lot of correspondence in the local papers about our image and the quality of life here. Harlow has even been labelled Grief City in response to some strikingly violent incidents and anti-social activities that look to be out of control in some areas.

Can Harlow be saved? In the absence of the sort of elaborate conspiracy theories discussed by Frank Furedi there is no conscious plan to let the town rot so that we accept an anonymous future as part of the sprawl of London. It looks like our present condition owes more to the existence of the sort of wicked problems that affect much of the UK, causing honest paralysis over difficult questions. Wicked problems arose in the area of public policy and are described as "a set of problems that cannot be resolved with traditional analytical approaches".

However, it looks like some of the recent correspondents believe that the moment has come for one of the flagship post-war New Towns to give up its identity and hope.

Is there any reason for this not to happen?

It is the nature of wicked problems that unanswered questions and chronic issues can take years to work out or never be satisfactorily resolved. One is make-or-break and needs to be dealt with immediately. It concerns hope in our future. People get involved in their neighbourhoods and work their fingers to the bone to maintain their families, homes and lives, but they find it harder when they believe that their community has failed them. We need to believe that our community is willing to protect and support our efforts. Citizens of all ages, businesses and social enterprises all need to believe that there is a commitment before they continue to spend their resources and stake their futures in Harlow.