Could the NHS reinvent itself?
As society starts to examine its relationship with mental health, I'm wondering whether its time for the NHS to reinvent itself!
At Psychologies we’ve had the recent theme of reinvention, and this has been an interesting subject for me to reflect on. It’s the 70th Anniversary of the NHS this year, and reinvention is a word that I think is pertinent at this time.
I’ve struggled to put my thoughts about the NHS down in a blog, because I have huge respect for my colleagues working in the NHS. I will also admit that I’m a little scared to be seen to criticise such a huge powerful organisation, because I am afraid that my thoughts will be dismissed as “too female” or insignificant. But I’m going to do it anyway, because I believe that my 21 years in the NHS give me ample experience from which to comment, and I’ve developed the courage to speak up and question the “status quo”.
There are many articles I could write about the terrible financial constraints on the NHS, and the current crisis with an ageing population and ever more expensive medical interventions. However today I want to focus on Reinvention.
In my view, the medical profession needs to reinvent its relationship to Caring. Historically the (male) doctors did the tough talking, the diagnosing, the heroic interventions, and they left the Caring to the (female) nursing staff. There still seems to be a subconscious belief that caring, compassion and supporting, are not for doctors to worry about. Of course there are great examples of individual doctors who have been very caring. They have had to push against the culture of the profession which dismisses Compassion as a “soft skill”. It focuses the education of new doctors on teaching them many facts about the anatomy and workings of the human body, pharmacology, and more latterly genetics. Whilst this learning is essential, my experience as a GP tells me that all the medical knowledge in the world is no help if you can’t listen, connect, and communicate with genuine compassion.
As a junior doctor, I was frequently told I cared “too much” when I spent extra time with a dying patient, or reflected on the difficulties one of my patients experienced. Was this caring too much, or am I just prepared to feel? To me, being someone’s doctor has meant having the privilege to walk alongside them during a potentially scary experience, and my role is to listen, guide, or advise where appropriate. It’s easy to build walls in order to cope as a doctor (it is a very stressful job!) but what do we lose by disconnecting from the pain? We lose the ability to empathise, to anticipate struggle, or to just be with someone in their suffering.
What we know about medical complaints is that a significant percentage are due to communication issues. Patients and their families are rightly upset when they are treated dismissively, without thought or compassion, or just not told information clearly and kindly. We also know that when health systems are under pressure, it is compassion and communication that suffer.
Apart from my work as a life coach, I also work as a GP Advisor for Macmillan Cancer Support. Macmillan has spent thousands of pounds setting up services that provide better support for cancer patients, and improve communication with patients and families. I am very proud of what we are doing, but I also question why it is left to a charity to provide these services? What does that say about our core values in medicine in the UK?
So why do I feel there needs to be a reinvention? I think that medicine has lost its way, and I think it is time to pause and to reassess what we are trying to achieve. Society has changed and many patients struggle to cope alone, without extended families and in communities that are not well connected.
What I noticed as a GP was a system that looks surprised when a patient struggles emotionally or psychologically, and has absolutely no resources to provide support. As a GP I would daily identify patients who were anxious, or depressed, or suffering domestic abuse, or who were struggling with terrible symptoms such as MS, but have no support services to offer them. The limited psychological services were overwhelmed and would only offer generic evening classes, which if you’re housebound and isolated, isn’t much help.
In order for this to change, I suspect as a society we need to address our own attitudes to mental health and psychological distress. Perhaps we need to speak up more about our struggles, and be prepared to question what support we need. We might also need to consider that if the NHS can’t afford to provide support services, we might need to create more caring communities, or start paying more into the NHS.
I also believe that we as doctors need to challenge the core beliefs of the medical profession. Who are we working for if it’s not the patients and their families? Is it time for medical staff to learn how to be more compassionate to themselves, so that they can connect with their patients rather than building walls to protect themselves? Learning the skills of self-compassion have allowed me to better cope with stressful situations, and not to shy away from difficult emotions. And could we all start to believe in better, to demand that politicians engage in cross party talks about creating an NHS that truly serves the people?