The NHS is in crisis. Browsing the 23 July issue of the British Medical Journal I can see that Covid continues to disrupt, ambulance and hospital wait times continue to rise, whilst more than half of advertised consultant physician posts have gone unfilled.
Some Conservative politicians have argued that taxes cannot rise to fund the NHS, whilst the Conservative leadership candidates have even argued for tax cuts, despite all the foreseeable consequences on public services.
There are issues regarding how we spend NHS money, and we have seen quite a few examples of poor spending during the Covid crisis. However, the fact remains that in comparison with many developed nations we have fewer doctors, fewer nurses and fewer hospital beds.
It is difficult to avoid worrying about how unsatisfactory things could be when one needs medical treatment. However, in this article, I want to focus on how we could all help ourselves.
When I was diagnosed with prostate cancer, I did some reading about my condition and what I could do to improve my outcomes. I also joined a prostate cancer support group. With prostate cancer, there are frequently different treatment options which may carry different risks or cause different side-effects: an informed choice is required.
It is useful to gather some information before any medical appointment: it helps to clarify what questions one would like to ask, bearing in mind that any medical consultation is by necessity time defined.
When I was working as an NHS Microbiology Consultant, I often came across patients suffering from frequent urinary infections.
An approach I often recommended (in line with some Canadian guidelines) was to offer pre-emptive antibiotic prescriptions so that patients suffering from these recurrent infections could self-initiate treatment when appropriate. This would result in faster recoveries and reduced patient consultations. It would also be better than prescribing long-term prophylactic antibiotics.
Our ability to obtain and understand information about medical conditions, and how to access the health services, is often referred to as “health literacy”. There are a number of medical publications suggesting that better health literacy leads to better health outcomes in patients with cancer or with chronic conditions such as diabetes.
A related but distinct concept is “patient activation”, defined as having the skills, ability and willingness to self-manage some health conditions (within limits). This is also conducive to better outcomes in chronic conditions whilst reducing the utilization of overstretched health services.
Mark Britnell, in a book on the healthcare workforce crisis, makes two important points. Firstly, healthcare spending is an investment: as we live longer, we need to carry on working for longer, but we can do this only if we are in good health. He also argues that patient activation is a necessary strategy to reduce both the usage and the cost of healthcare services.
Whilst my friends in Italy have easy online access to their blood test results, and can easily check what was their last cholesterol levels or glycated haemoglobin result, here in the UK we have to ask each time for a copy of our results.
Some GPs may worry that giving access to blood test results may conduce to many more enquiries but, in my Italian experience, this is not the case as patients will look first for explanations online (we need a strategy to direct to trustworthy websites) or from patient groups and may then think of better questions to ask at the next scheduled care appointment.
If we are aware of our cholesterol blood levels, we may be more motivated to adopt lifestyles that reduce the risk of cardiovascular disease. Conversely, if we were more aware of a borderline glycated haemoglobin result, we might be more keen on adopting healthy diets or shedding some weight, as this can actually prevent progression to diabetes.
Better health literacy and patient activation may not be suitable for all patients, but a shift away from the current paternalistic approach would benefit many. Increasing taxes to fund better healthcare maybe necessary but not adequate, unless many of us become active participants in seeking better health.
A more vigorous public health policy and a better health information strategy are also required.
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