By Dr. Derek Doyle (UK)
How true! Expressed another way, history is always repeating itself. Much as we may want to deny it, this applies to medicine as to anything else.
As many readers will know the British National Health Service (NHS) is going through difficult times – falling standards, targets not met, disappointed patients, many avoidable deaths, falling morale…and inevitably much soul-searching, apportioning of blame, mutual criticism, every politician knowing whose fault it is but at the same time unwilling, or more likely unable, to suggest a solution!
One politician, keen to run the NHS when his party gets into power, was reported as saying “I will bring forward a bill that legislates for whole person care that fully integrates health and social care.” In our world of hospice and palliative care, this used to be called “holistic care” or “addressing every need whether physical, emotional, social or spiritual.” Familiar? To all of us, it made sense, not least because it was not an idea created by us, or the pioneers in our work, but it was what our patients and their loved ones told us they needed and, as is so often the case, they were right.
It would be churlish to boast “We thought of that before you did!” This is a chance for us to check if we are indeed offering truly holistic care, evaluating that care model, and teaching it to our students and trainees, whatever their profession. We may find that, unnoticed by us, we have become a little like the NHS!
I know of palliative care services whose staffs are not prepared to see patients in their own homes; units where a chaplain or “spiritual counselor” is only permitted to see patients who have been referred to them; units which never admit patients during the weekend; units which discharge patients home at the weekend when their family physician is not available and no care package is in place.
We ought to be able to put up our hands and say to politicians, health care planners and fellow clinicians “ We’ve been doing that for many years now. We have subjective and objective evidence that it works, that patients and their families really appreciate it, and in the long run it does not cost more than today’s care fiasco with so many unnecessary tests and investigations, to say nothing of expensive therapies with little or no chance of restoring quality of life.”
Not new? Of course it is not new – what is?! Why do people have to be as old as me to remember there is nothing new in this world? The quotation at the top of this piece was written at least 3000 years ago. Like many TV programs – what we are looking at is often a re-run. As long as services, like the NHS, go through difficult times let us be bold and gracious enough to show them how we do it – because it was the “consumers” who urged us to do it this way.
Dr. Derek Doyle
Dr. Doyle is a Lifetime Board Member of the IAHPC. His bio may be found here.