Listening and measuring

GP income (via QoF) is to depend more than ever on increasingly tighter control of our patients’ blood pressure, diabetes and health-related bahaviour and the collection of ever-increasing amounts of data of little or no relevance to patient care.

GPs in deprived areas will be adversely affected, since most chronic disease management depends not on GP behaviour, but on patient self-motivation. According to the hierarchy of needs of patients where I work, finances, employment, housing, freedom from violence, relief from anxiety and depression and social opportunities to help alleviate boredom, isolation and loneliness, all come above managing hypertension, cholesterol, medication or exercise regimes.

Pertinent to GPs wherever we work is the impact on the doctor-patient relationship of the electronic templates that dominate our patients’ medical record, rather than our patients’ agenda. This paper by Swinglehurst and Greenhalgh provides evidence to back up what many, if not all of us GPs and patients are experiencing: our ability to pay attention to our patients is being severely compromised. Electronic alerts pop up incessantly to remind us that the patient sat in front of us, trying to get our undivided attention needs to be weighed, offered smoking cessation advice, counseled about their alcohol intake, advised to exercise more, reduce their cholesterol and be screened for dementia. Without which we stand to lose money which ultimately means less doctors and even less appointments and time to hear our patients’ concerns.

Much of what is really important, the ability to listen seriously and have meaningful conversations with patients is being lost by the demand that every interaction is measured by data collected, diagnoses made, investigations ordered, treatments prescribed and the procedures undertaken rather than seriously paying attention to what our patients need to say to us.

I’m slowly bringing my next, long blog about loneliness to a conclusion, and it’s clear that if we don’t make time to listen properly to what our patients are telling us, we will treat every type of distress and every presentation as a disease to be coded, investigated and treated. If this happens we will have failed at our most important gatekeeper role, not the one between GP and specialist, but between suffering and disease.

See also:

Computer templates in chronic disease management: ethnographic case study in general practice BMJOpen

Reflections on a Half a Century of Medical Practice: The art of listening to the elderly patient. Bernard Lown

Narrative-based medicine. BMJ series.

Medically Unexplained Stories. John Launer

Love’s Labour Lost, by Iona Heath

An epidemic of loneliness. Lancet.

When Computers Come between Doctors and Patients. NYTimes

Computer use must not affect doctor patient relationship BMJ

Computers take away doctor-patient relationship Murray Feingold

Half of doctors too busy using computers to look patients in the eye. Daily Mail

Courtesy of Jonathon Tomlinson via Abetternhs’s Blog