Dr. David Pearce is a Self Management Support Fellow with the Health Foundation in the UK. He is the Clinical Lead for the Co-creating Health team in Torbay in south-west England, part of a multi-centre programme, initiated by the Health Foundation, to promote self-management and collaborative working between patients and health service staff.
Though this programme has many facets, uppermost in my mind at present is a patient whom I saw in my clinic just last week. My first question to her was something like, “So, what’s brought you here today?” and she replied “Well, I don’t really want to be here; it’s to stop X (another health professional that she sees regularly) going on at me about it.”
This was a lady who was intelligent, independent and articulate but her long experience of the health service had somehow led her to a position where she had become a recipient of care she didn’t want. Yet it could have been different. By empowering patients and collaboratively setting goals based on a jointly set agenda, we can release the greatest underused resource our health services have, the patients themselves. I have been involved in training staff in techniques to promote this collaborative working, which we call the Advanced Development Programme. Our aim is to promote a shift in the balance of power in the health service towards each contact between patients and health professionals being a meeting between two equal and complementary experts. Here I mean the health professional being an expert on the condition, and the patient being an expert on themselves and their own particular needs and values.
However, after years of new initiatives, many health service staff are undergoing "change fatigue," which is exacerbated by the current financial stricture. In this climate, the danger is that our clinician training becomes just another course, which is quickly forgotten. Yet we have now trained the vast majority of local primary care doctors and our most effective advertising has been past attendees. They have found that working collaboratively with patients brings genuine improvements in their job satisfaction.
Using these skills, doctors have told us of their ability to help previously 'stuck' patients to move forward. One talks of being able to finish their clinic on time for the first time in their career by using joint agenda setting. Even very simple, small changes in the doctor-patient interaction can produce big improvements and financial savings. For instance, considering the patient above, as part of the training we encourage doctors to ask, "Would you like to be referred to..." as opposed to saying "I am going to refer you to ...". Using advice like this led to one practice having a 30% reduction in secondary service referrals for mental health.
Whilst we are only a small team in Torbay, we have shown that the use of self-management techniques can produce positive changes in patient health, clinician job satisfaction and financial savings. We are passionate about self-management and its promotion and would welcome comments or questions. My email address is: firstname.lastname@example.org.