Tuesday, February 15, 2011

Relieved of the need to think

I was recently at an event planning meeting in which I heard that the local doctors in our town find it very hard to live up to the expectations of the very large Polish population we have. Apparently, "Their expectations are very high," and their confidence in British doctors very low. I was the only non-British person present at the meeting, and it was pointed out with some surprise that Poles know "the names of all the different types of doctors" and expect to be able to access these directly.

It sounded rather as if the Polish medical system was not dissimilar to the one I knew in South Africa. If you have a skin disorder, you make an appointment with a dermatologist. If you're a woman, you make a routine annual visit to your gynaecologist. Until your kids are 12, you are just as likely to take them to the paediatrician as the GP. You know your radiologist from your oncologist, and your ear, nose and throat specialist from your cardiologist.

In the UK, the practice is that you go, in the first instance, to your GP. Always. You will then be referred to a consultant. And that process can take months. Been there. Done that. Nine months for me, last time.

When I expressed surprise that the well-educated, otherwise knowledgeable people present at the meeting didn't know "the names of all the different types of doctors", one person rather proudly pointed out that, with the way the NHS works "we don't have to!"

I had often wondered why all specialists were rather generically referred to as 'consultants', but this explains it. You see a generalist. The generalist refers you to a specialist. The specialist's secretary sends you the details of your appointment. You attend. The specialist reports back to your GP. Your GP reports back to you. You don't ever initiate contact with the specialist. So you don't need to know what sort of specialist s/he is.

I find this approach quite disempowering. I don't feel the need to be looked after in this way. I feel quite capable of identifying the specialist discipline needed in each instance and making an appointment. I feel quite capable of providing said specialist with an accurate history and conducting a conversation about my ailment/condition.

Many Poles obviously experience the same frustration, because they are quite prone to taking their ailments back to (as one Polish woman puts it) "a proper doctor" for a diagnosis that they feel they can trust. This doesn't really help, though, because when they come back from Poland, and feed the information back to the local doctor, the local doctor will not accept histories or diagnoses from abroad, and wants to go back to the start of the process again.

I can think of so many situations in which traditional workplace practices reflect a similar approach. I would far rather see individuals given the freedom to run their own initial diagnostics and then to access to the resources they believe they need in order to get the information/support required, apply it and move on with the day job. Of course they will get it wrong from time to time. That's part of learning, too.

Too much second-guessing can result in a culture where people are waiting to be taken care of, to be told what to do next, have no idea which kind of person/resource holds the solution they need, instead of taking charge of their own lives and figuring out their own 'what nexts'.

Sometimes, taking too much care of people is even worse for them in the long run than taking too little care of them!


Views from Malmesbury said...

Not sure about this one Karyn. If you've got shoulder pain do you go to a physiotherapist for a muscular problem, an oncologist for the possibility of bone cancer or perhaps a rheumatologist for an inflammatory disease? By going to a General Practitioner the theory is that the GP can ask the appropriate questions to narrow down the possible causes and refer the patient to the relevant consultant. I don't suppose the GPs get it right all the time but surely they must be in a better position to refer to the right place than the general public? I rather like the system we have, flaws acknowledged. If anyone has so much faith in their own system in preference to ours, why are they coming here? I'm assuming of course they have a choice since you mention they can go back to Poland and come back again with their preferred consultant's diagnosis. I'm not trying to be difficult, I simply don't understand.

The upsycho said...

@Views Whoa! You're venturing into well-known, and deeply unpleasant territory, there. We expats get an awful lot of "Why don't you just go back where you came from, then?"

There are many reasons for leaving one's home country to make a home in another, and from that moment on, there will always be frustrations. Because no matter how much better things are in the new country in one area, there will always be areas in which things were better or more efficient 'back home'. No country is perfect.

If you have always lived in the UK, you will not have seen any other medical system in place. But for those of us who have experience of a more efficient system, the slow grinding of the NHS and the high-handed attitudes towards the patient beggar belief.

Let me give you just one example: My husband went to see a certain specialist in Cape Town because he had a health problem that fell within that specialist's are of expertise. It happened to be a Tuesday. The specialist suggested surgery and asked my husband "Are you available on Thursday?" The surgery was performed that very week. And it wasn't an emergency.

By contrast, when I fell down the stairs and badly injured my neck, the NHS scheduled me an 'emergency' MRI which took place 6 weeks later, and an 'urgent' nerve conduction test, which took 3 months to happen. It was 9 months before I got to see a surgeon, by which time I had effectively lost 9 months of my life to blinding, incapacitating agony.

In the case of the Poles (and various others) 'home' is near enough that they can shuttle back and forth for treatment if necessary. However, the unemployment levels there, and the state of their economy make a permanent return impossible (although I know of many who have done so).

For me, returning home for a diagnosis and/or treatment involves a 22 hours of door-to-door travel and expenses I can't afford to meet.

There are many things about UK society that are wonderful, but the health care and the education system are not among them.

All this, however, is slightly off-point. I was trying to draw an analogy to workplace learning. I obviously didn't do that very effectively.

V Yonkers said...

What is difficult for me to understand (the US system has a hybrid where some health care plans require everything goes through a GP while others let you go directly to a specialist) is that you (the patient) do not seem to discuss the treatments with the "consultants." If they are specialists, then there should be a dialog between the GP, the patient, and the specialists to come up with the best treatment plan for the patient. The specialist understands the disease or injury, the GP understands the patient's medical needs (past experience, allergies, pain thresh hold etc...) and the patient knows what they are comfortable with, the type of support they will need for recuperation/treatment, their own body. By working collaboratively together, the best solution can be discovered.

Likewise, letting an employee just run with their own training does not always work. There needs to be consultation between the supervisors and heirarchies who have a perspective on the company needs, the specialists who have access to resources and experience that they can give insight on, and the individual who knows their limitations and strengths. It seems that there is too much "individualism" being promoted (at least in the US) in the workplace today when there is a need to have closer collaboration.

Of course, your example doesn't even bring up the issue of trust. It seems that the Polish system puts a great deal of trust in the patient (they will not abuse the system, they will seek help when it is necessary) whereas the British system puts a great deal of trust in the GP's (they'll ask the right questions, they have the welfare of their patients in mind, they won't abuse the system by passing off tough decisions to the healthcare system). This is where the cultural differences really come to play.

Views from Malmesbury said...

I apologise Karyn, I didn't intend that to be taken as a pop at ex-pats; I've re-read my comment and can see where you got that from. I'm actually pro-immigration. After all, we're all immigrants in the UK if we go back far enough and I believe it's this periodic influx of new blood and ideas that has made the British what we are, and for the most part I like what we are. I just think it's less painful for everyone if it's towards the controlled immigration end of the scale rather than the invasion end. But I digress! My focus was meant to be on the matter of starting with a generalist and going on to a specialist. I still think this is a good thing. Agreed, the administration of the system leaves a whole lot to be desired, I've been a victim of inept administration and cumbersome procedures too, on a number of occasions! However, the principle seems good to me if it could be made to work. That's not to say they couldn't communicate more with the patient. I've found specialists these days communicate somewhat more than they used to but still without a full appreciation that it's our body and life not theirs that they're dealing with and we have a right to proper explanations at a level we can understand. However, I know of a lot of people (admittedly more elderly people but not exclusively so) who would find the prospect of deciding who to go to an insurmountable problem. Perhaps, as with so many things, the answer lies somewhere in between the two systems of self-referral and professional referral?

Views from Malmesbury said...

Yonkers has summed the situation up beautifully in my view. Collaboration, that's the key. And an excellent point regarding trust.

The upsycho said...

Hmm. It's been a long day and my brain is fried, but I think that @Virginia's comment kind of addresses @Views' latest one.

There is the whole trust thing, here. I prefer to feel that I am trusted to make the right decision in respect of my health. That, if I know which specialist I should speak to, I can go directly to him/her. But, if I'm not sure, I can go to my GP for a referral. If I accidentally select the wrong specialist (or if my GP does, because I am assured this is almost as likely), the specialist will steer me in the right direction.

And this is where the whole thing relates back to workplace learning. If you know what it is you need, you can find it on your own. If you don't you can ask someone to help you... the 'bloke at the next desk' learning methodology (my personal favourite).

What we need to be doing is encouraging people to take a greater measure of control and to start to feel brave enough to find their own solutions. As long as there is a culture which swoops wrathfully down on the first hint of failure, we won't get there. Ditto as long as there is a culture in which the ownership of an individual's development is in the hands of the HR/L&D team.

I hope my tired synapses have managed to articulate that adequately.