A story that caught my eye whilst perusing the media for “Health headlines” this week was an article discussing the results of a survey that found an astonishing number of women won’t seek medical help for so called “embarrassing” medical conditions.
Typically the survey was heavy on the “whats” and light on the “whys” so it left me thinking about why women wouldn’t feel they couldn’t talk to a medical professional about an intimate issue.
When I considered the process of getting to see a doctor myself, the reasons seemed clearer. Lets have a look at a potential encounter.
First you call the surgery. You may have to wait for quite some time on the telephone before speaking to a receptionist who will then enquire as to how urgent your need is. Thankfully at my surgery they don’t ask you what your problem is though I have heard of this being done in other locations. If you have a non urgent enquiry you will likely be offered an appointment a number of weeks in advance. It is very unlikely you will get to see the doctor of your choosing because everybody else wants to see them too and they will only book about 4 weeks in advance. You either have to plum for whoever is free or call back another time. If you say your need is urgent you will be referred to telephone triage and a nurse will call you back. You then need to discuss the basics of your condition on the phone with someone you have probably never met who will then decide how urgent your need is and offer you an appointment, again a pot luck of availability. At this point you have no idea of the extent of investigation your problem will require. Will you need to be examined? Will you need to discuss personal issues?
When your appointment finally comes round you have a ten minute window to discuss the issue. The doctor is under immense pressure to find the solution and update the computer. You may or may not have met them before. You may or may not have a rapport with them. They may or may not be having a good day. You may be asked to strip off and have an intimate examination. Have I sold it to you yet or do you think you might just soldier on with your ‘intimate problem’ until it either goes away or becomes unbearable?
The reality is that if you do need to discuss an intimate (Embarrassing is frankly an insulting term) problem there is a very high likelihood that you will be treated with a high level of professionalism and respect. There are policies and rules in place to ensure that a patients rights, dignity and safety are of paramount importance at all times. The problem is that we have completely lost the human element. Trust isn’t built on the basis of policy or rules its developed with empathy and consistency over time.
A few years back, everyone knew their family doctor. In our modern “rush rush rush money money money” society this is scarcely found and as a result health ‘care’ has become a process as appose to a therapeutic relationship.
So what is a therapeutic relationship and why is it important? Well thankfully I don’t have to work under the same pressure as a doctor so this element of healthcare is a more integral part of what I do. In practise it looks a little something like this: New patients are usually booked in for an hour and a half first appointment. We spend a long time discussing all aspects of their health. They may feel they can open up to me during this time, they may not, but they can come back and see me as often as they want, with or without current symptoms to work together on their health goals. Whilst i make recommendations, the patient dictates the pace and intensity of treatments. If we spot something unusual or potential of concern, we discuss the appropriate course of action. Where necessary (and always with permission) I will write to their doctor or other health professional. the patient feels supported and in control and hopefully able to talk to me about anything in safety and confidence because they have come to know me.
So obviously I’m suggesting our doctors follow this model? Well obviously in a utopian world this would be the ideal the solution but in the real world it simply isn’t practical. Health services are at breaking point already.
Where I think the compromise lies is in a fully collaborative approach. First of all, we as a culture need to stop viewing health as the status quo and invest in maintaining it rather than fixing it. Complementary therapies like massage, acupuncture, counselling can all play a part in improving how we feel about ourselves and give us the opportunity to form the type of therapeutic relationships that make us to feel safe and open about areas of health that give us concern. For our part, the health industry need to put the needs of the patient first and recognise the value of working with each other. Better communication rather than fighting and posturing about who is best, cleverest, right or wrong. Only this week I was listening to a radio programme where acupuncture was again dragged through the dirt over an area of medicine where dedicated professionals support patients through an enormously emotional and traumatic procedure. Perhaps its time we started focusing more on the benefits. There are plenty of cases where complementary therapists like myself have spotted potentially serious health problems simply because we’ve had more time to investigate, observe or examine a patient or because they have felt able to discuss concerns with us in the treatment room. When this happens we aren’t trained to sit there congratulating ourselves or make promises of miracle cures. We are trained to alert doctors or refer to the most appropriate form of treatment (always with permission I hasten to add).
To me this is integrated medicine. Health professionals working together to put the needs of the patient first and breaking down those barriers like the ones from this survey.