Tag: mental-health

What is patient-centred care?

What do we mean by patient-centred care? This isn’t a trick question but an attempt to reach a consensual answer.

A common response is that it’s about placing the patient at the centre of the care process, and seeking to address what matters to them, akin to a tailor made suit, rather than using a ‘one size fits all’ approach.

Some definitions focus on the responsibility of health professionals to inform patients about their healthcare and give them a choice. It could be more than this, with patient-centred care being about the partnership between practitioner and patient, with this relationship rooted in sharing power, rather than upholding a paternalistic attitude.

It does not mean doing everything that a patient asks; it is not ‘patient centred’ to give out diazepam and opiates without restriction when the consequence can be a hard-to-manage addiction. Being patient centred in this scenario might include a discussion about the reasons for a request, negotiating and sticking to a management plan, arranging additional psychiatric support, or a number of other options.

Patient centred care is also about designing services that meet the needs of patients rather than the needs of the organisation. This implies that the public should participate in the planning and redesign of services, and the reshaping of policy.

There are pitfalls. One commentator points out: ‘Three proposals topped a poll of options for reform at the ‘listening exercise’ attended by more than 1,000 people in Birmingham: extending GP opening hours, annual health MOTs and more walk-in centres. This familiar list of the preoccupations of the professional middle classes confirms the way in which this focus group approach places the demands of the worried well over those of the seriously ill (or even of the not very well, but socially marginal).

‘Listening exercises’ tend not to include those who are ill, particularly the elderly, children, people with mental illness or learning disabilities, families with young children, those who are not fluent in English – in fact, the majority of our patients and certainly those patients most in need of healthcare services. These proposals will increase costs out of all proportion to benefits and are likely to disrupt continuity of care for those patients for whom this is the most important aspect of primary care services.’

The concept of patient-centred care encompasses all of the above – from the organisational, redesigning services end of the patient-centred care spectrum through to the individual interactions side. However, health professionals, educationalists, managers and patient representatives are all developing different meanings that reflect their own history and position. Without a consensus about patient-centred care, it is hard to see how we can agree on how to deliver it. 

Being patient centred does not just mean responding to the demands of a vocal few. It is also about providing accessible, reliable care to the sick, the sad, and the frequent attenders, and treating all patients with common decency.

Realistic medicine saves the planet? Sustainability, environment and health

I am Dr Kate Dawson, one of the GPs at Benbecula Medical Practice in the Outer Hebrides. I have been working here since 1990, with three short breaks to complete some training, and when I had my babies, who are now grown up. We are lucky to live in a beautiful and precious place, which is generally safe and kind. I love gardening, knitting, and observing our wildlife when I am out walking.


Our islands, though, are very vulnerable to change. Global warming is bringing unpredictable weather, and rising sea levels will change our coastlines. It is getting more difficult to recruit staff, and travel links are not as good as they were a few years ago.


In the face of this, I have been considering the sustainability of the healthcare system that I am part of, and how we can make positive changes that will help our patients achieve better health, and at the same time, reducing our impact on resources. I dived in to think about this in more detail in the last year and found more than I thought possible.


What does sustainability and the environment mean in terms of health care? Here are some of the ideas that may affect patients directly. Some items will not surprise you, others might.

  • Patient transport. This includes trying to use active transport such as walking and cycling, using electric bikes and electric cars. This can be hard when distances are long, and our roads are narrow. However, this also includes trying to avoid travel to appointments when a phone call or video link would be as effective.
  • Waste management: Unused medication should be returned to the surgery for safe disposal, so it does not cause environmental contamination. You can also help by only ordering what you need when ordering repeat prescriptions. Empty inhalers and insulin pens should be returned to the surgery. Incinerating empty inhalers causes less damage than the gas in the inhaler being left in the environment.
  • Better prescribing: As an example, inhalers have a particularly detrimental effect on the environment. One MDI inhaler is as damaging as a drive to Inverness, whereas one breath-activated inhaler is equivalent of a drive between Griminish and Balivanich. Unnecessary and ineffective medication is a waste too. Don’t cut down on your inhalers, get advice about managing your asthma more effectively, use your preventer more, and ask to try a switch to breath activated inhalers.
  • Better decisions: Better discussions about treatment and referral help patients and doctors make better decisions. If you are referred for a treatment that you Don’t really want, or which may not benefit you much, then it is far better to discuss this before the travel, prescribing, tests and worry begin. It begins with talking frankly to your GP about the benefits, risks, and alternatives to the proposed treatment, and to ask what would happen if you did not seek treatment. Take someone with you if you need support with these discussions.
  • Good health is more than medication: Our current medical model from the twentieth century has been about patients coming to the doctors, their ailments quickly assessed, and a treatment or procedure prescribed. With authoritarian health care, the patient can become a passive recipient of medical care, and every ailment is met with a treatment or a procedure. There may be another healthier, less wasteful, more sustainable way.

Imagine this; you can improve your appearance, reduce your need for medication, your reliance on health care, improve your energy levels and joy in life, the benefits will last for years, and the cost is minimal. I am really excited with the possibilities. What is the secret? What if everyone could do this, it would reduce reliance on health care resources, and we would live to enjoy health into our retirement. I am talking about improving health by improving fitness.


As an example, the most cost-effective treatments for Chronic Airways Disease (COPD) are physical activity, smoking cessation, and flu immunisation. These three things are associated with better outcomes than any inhaler or medication.


I am using the word ‘fitness’ for a good reason, as it covers lots of concepts. It does not focus specifically on weight, or exercise, or smoking, or alcohol. It just focuses on being healthier. Where should you start? The beginning is to think about what you want to improve, to imagine what your goal is, what is driving you to consider making a change. Give yourself permission to write down or say aloud what you want to change, what could be better. Perhaps you want to be less short of breath, or your knees to hurt less, or to feel less lonely. Your goal will inspire you to keep trying. You could list all the things you might want to change and work out what you need to do for each thing.


Don’t try to change everything all at once. It is better to focus on one easy thing at a time and make it about fitness and fun. This year, for example, I plan to go for a walk at least once a week. If I miss a week, I have given myself permission to try again the next week, and not to give up when I fail. Last year, we started using smaller plates to reduce our portion sizes without cutting out our favourite foods. You Don’t need Lycra, or to run, or to go on an extreme diet, just find one thing that you can do, that you can enjoy, and make that into a habit that you can sustain.


Who are your allies? Have you got a trusted friend to talk to? A professional such as a physiotherapist, counsellor, nurse, or doctor could listen and support you, if you asked for this; the most important thing is to find someone who can listen to you. They may help you work out what you might be able to do next, to identify one thing that you can do easily, and to support you too.
Your one change may bring more benefits than you think. Going for a short walk will improve your fitness, and it will also raise your mood, reduce isolation, and ease joint pain. Meeting up with someone else for an activity such as knitting or singing will improve your mental agility, and will also reduce isolation, low mood, and loneliness.


As you start to improve your health, you may inspire others. We could have a new normal, in which we support each other to take steps to improve our health through simple changes to our lifestyles, reducing our reliance on medication and leading more fulfilling and joyful lives. We can help the environment and the NHS stay sustainable by creating our own better health.


For ideas, why not listen to Michael Mosley’s podcast ‘just one thing’ on BBC sounds.
https://www.bbc.co.uk/programmes/p09by3yy/episodes/downloads