Thursday, 28 July 2011

The curse of the pro-forma

I was at a conference yesterday focusing on the important subject of dementia.  Costing the NHS vastly more than cancer services, it nonetheless receives much less attention and relies on a whole army of volunteers to provide 24 hour care and support. With a growing number of people reaching older age and consequent vulnerability to dementia, it's a huge challenge not only for the present, but especially for the future.

During the discussion time a number of GPs expressed frustration over the difficulty of obtaining appropriate and timely advice in assessment and the management of the agitated, distressed patient, when almost invariably there will also be an exhausted loved one struggling to go on caring. One doctor commented that his patient had been assessed by the local old age psychiatry team, whose only contribution was to suggest referral to a memory clinic. Sadly this in no was addressed the acute, fractured nature of the situation.

At one point it was suggested that a pro-forma might help communication between the doctor and the mental health team. My heart sank. If there's one thing pro-forma's lack it is the ability to express the nuances and essential points of a situation. Pro-formas rely on almost mathematical answers to questions which don't always lend themselves to neatness. OK you can find out how old the patient is, what drugs are being prescribed, and whether the patient has been screened for infection, but what about the more subtle things of life? What about the relationship with the caring spouse, what about their loves and hates, what about the people and circumstances of life that are most calming to them? One problem with pro-formas is that they obscure by asking too many questions, and another is that they don't prioritise what really matters. In short they just don't give a very helpful picture of the person.

My youngest daughter is a junior hospital doctor. After a recent appraisal and multiple box ticking with her appraiser, she came away thinking that the appraiser just had no idea what she was really like. And also that the appraiser had not grasped at all how she was finding the experience of being a doctor. It was just, cannulate..tick,  audit completed..tick, no disciplinary issues..tick. And so on.

A plea for some humanity in medicine.
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