Thursday, 23 October 2014

Low-tech effective medicine

The media loves high-tech, expensive medicine. Brain surgery, complex management of the critically injured person, or super specialist management of cancers gain much acclaim, and big tv audiences. But what about medicine in the second line trench? What about the soft stuff of talking and empathy and time given?

I thought about this after speaking to a patient who some while ago  had recovered from a serious brain bleed, only to then nearly succumb as a result of the treatment given at the time. She had been terrified-since she was awake during the life saving treatment-but had survived. So when I phoned her to ask how she was doing, it wasn't until I said, 'and how are things emotionally?' that the flood-gates opened. There was a pause, and then sobbing, before she was able to say that no-one had asked her that before. It had been presumed that because she had recovered, she would be living a perennially grateful and happy existence. But not so.

As we talked it became clear that the near death experience had significantly scarred her. She was experiencing flash-backs, she was struggling to do the normal things of life, like cleaning, taking the children to school and enjoying being part of a family. Indeed she was suffering from post-traumatic stress. But no-one had picked it up before, it's as if she hadn't been given permission to feel.

Hopefully with time and appropriate support and counselling she will regain her equilibrium. Of course she's mighty relieved that she survived the acute illness, but survival isn't everything. And it's in general practice that enabling a patient to live isn't so much about high tech, expensive interventions, but about the traditional GP skills of empathy, constancy (an argument against mere access as a priority) and broad picture thinking. Its not glamorous, but it's what I value most about being an 'umble GP.

The Long Walk

It's always a bit chancy to give someone a book. A little like recommending a restaurant. Will others like it? Will the service be as go...