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.

Allostasis means that the judgment of a GP who knows you and your medical history should take precedent over protocols. Allostasis means that you may need the attentions of a Respiratory Nurse Specialist, a Diabetes Nurse Specialist, a Falls Nurse Specialist etc. but you also need the attention of someone who can take care of your bedsores - a necessity for which there seems to be no provision - and meet your incontinence needs in a timely manner.

Allostasis requires that we should not overburden GPs and health workers with impossible situations that they can not remedy. Some patients seem to be receiving costly interventions that are not meeting their most essential needs. The solution doesn't seem to be more social policy or health service initiatives. From Dr. Crippen's writing, such initiatives range from the farcical to the tragic - and they are typically accompanied by extraordinary costs.

This is usually the point at which I throw up my hands and declare that this is a wicked problem causing honest paralysis over difficult issues. 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". It is the nature of wicked problems that unanswered questions and chronic issues can take years to work out or never be satisfactorily resolved. However, having read Dr. Crippen's recent entries, one issue is make-or-break and needs to be dealt with immediately. It concerns hope in the future for people who work in the NHS and live health care as their vocation. They can not become the fuel on the bonfire of the vanities of different professions and those who promulgate unworkable policies.

Copyright 2006, Tony Plant Happystance Project