A New Paradigm -
and much more
For many years since the foundation of the NHS, we have moved to a system
in which doctors have roughly ten minutes in which to see an appointment;
that can vary. In my own practice it is usually one issue per one ten minute
consultation. Doctors are encouraged to take longer if that is needed but as
ne of my doctors told me, "I have a wife and a new baby and I a not hanging
around here for extra time." In my practice we can, if necessary, ask for two
appointments as one if we have a situation which we know will need more
han 10 minutes.
Still, doctors are under pressure and if wwe think about it, how can they be
reasonably expected to do a fully examination, allow the patient to ask their
questions, discuss their concerns, then prescribe and discuss a treatment plan.
We know we are not well served by the present system. Doctors know it. And many of them suffer stress of their own or leave.
In January 2018, the Scotsman daily newspaper reported that Britons would live longer but would be afflicted by more illnesses. The number of older people diagnosed with four or more diseases, those often diagnosed with multiple morbidity, is predicted to double between 2015 and 2035. And a third of those will be diagnosed with dementia, depression or a cognitive impairment. By 2038, over the next 20 years, British men and women over 65 are expected to live 3.6 years and 2.9 years longer than older Britons now.
In short - we shall live longer but more of us less healthily. And the present medical paradigm is not designed to cope and not just from a resource perspective.
In America the numbers are roughly similar; one in four suffer from multiple chronic conditions i.e. those with on-going serious medical conditions such as a heart disease, diabetes, or cancer. Worldwide, chronic disease is expected to reach nearly $50 trillion dollars by 2050 —an almost unimaginable amount that is equal to the GDP of the six largest countries in the world combined.
Wherever we look at the rapidly increasing numbers of people living longer
and more of them with chronic conditions, most of the solutions being
proposed by governments are to throw more money at their health services
whilst only tinkering with the current conventional medical paradigm. More
money does not make for more effective outcomes if it is simply paying for
medical staff to continue as the present paradigm demands and for which they
In the UK, on the 6th October, listening to the main news in the morning, I
heard reports of trials at dozens of surgeries in the UK and the NHS scheme
aimed at saving cash and doctors’ time, whereby sufferers of long-term conditions –
such as diabetes, asthma and arthritis – are to be invited to group sessions with up
to 14 other patients, and an array of relevant medical staff to discuss their care.
The two-hour sessions are typically led by administrative staff or healthcare assistants. Doctors attend for around an hour to discuss any tests and treatments. Patients can ask questions and offer the benefit of their experiences to others in the group.
These sessions are to be rolled out nationally later this year as part of a new ten-year plan for the NHS in England.
As reported, it would seem the advantages are all about saving money and doctor’s time. Doctor’s won't have to repeat the do’s and don’ts of eg diabetes care to patients individually. The patient leaves with a feeling they have had much longer consultation time but exactly how much individual attention me does each patient get in these consultations especially if they are meek and dislike groups. And what happens to those who find it difficult to get their voice heard in groups or in later life are slow in thinking and speech? (True, people still have the option of individual appointments... but I can see where this is headed. )
A major concern is this – this is not just an issue of shifting a time paradigm. If all medical staff do is operate still out of the bio-medical model then they are ignoring all that people can benefit from a functional medicine approach where there is more focus on root causes and their treatment. Or integrative medicine which treats the "whole person," focusses on wellness and health rather than on treating disease. And then, amongst others, there is complementary and alternative medicine (CAM) treatments that currently fall outside mainstream healthcare and range from acupuncture and homeopathy, to aromatherapy, meditation and colonic irrigation.
So what if patients want to talk of cannabis, Emotional Freedom Techniques, herbalism, homeopathy, hypnosis, nutrition (in which doctors are singularly uneducated) or really want to dig down to the cause of illness – what will happen?
Whilst this new approach is to be welcomed in that it shows the medical profession is seeking a way through the present paradigm which simply is not working, it may throw up other issues. Patients may be dissatisfied if their concerns go unaddressed because a group session has been badly led or some patients or staff hog the attention. What then? Will there be more complaints or will patients be better supported to have the confidence to demand more radical change? Will the patients feel sufficiently empowered to influence an agenda which goes way outside the bio-medical envelope?
Or are we simply expanding time but still covering the same limited conventional range of services? I suspect yes, but this whole new approach may force some radical thinking that will, in time, shift the present paradigm.
And what of the present NHS focus on symptoms and the treatment thereof with insufficient time devoted to (a) finding the root cause of an individual patient’s condition and (b) the treatment and management of a condition?
We need to think differently in order to solve our problems and offer more than medication, surgery, and radiation.
We need to shift the paradigm from symptom suppression and disease management to “root cause resolution." We need to take more time to consider how one aspect of a patient’s life, even from time gone by, affects another, how e.g., a person’s life circumstances such as death in the family and the stress related to that, seriously impact a person’s health and behaviour. There needs to be a drawing of a mix of thebest of the following :-
A broadening of what is currently conventional medicine
An ancestral approach to diet, behaviour, and lifestyle, which prevents disease from occurring in the first place
A Functional Medicine approach which treats chronic disease by addressing the underlying and related causes of the problem, including the metaphysical and spiritual elements
An Integrative Medicine approach which often brings conventional and complementary approaches together in a coordinated way. It emphasizes a holistic, patient-focused approach to health care and wellness—often including mental, emotional, functional, spiritual, social, and community aspects—and treating the whole person rather than, for example, one organ system. It aims for well-coordinated care between different providers and institutions.
Complementary Medicine approach which according to the British Medical Journal "refers to a group of therapeutic and diagnostic disciplines that exist largely outside the institutions where conventional health care is taught and provided. Complementary medicine is an increasing feature of healthcare practice, but considerable confusion remains about what exactly it is and what position the disciplines included under this term should hold in relation to conventional medicine"
Metaphysical Healing. As medical science proved its effectiveness in treating the human body, the mental and spiritual aspects of healing fell by the wayside. Metaphysical healing is based on the belief that negative mental patterns, left unchecked, can eventually result in physical disease or illness; and that the reversing of those negative mental patterns into positive patterns can in turn lead to healing.
Naturopathic Medicine (Naturopathy) which comprises practices such as fasting, nutrition, water, exercise and approved natural healing practices such as Homeopathy, Acupuncture, and Herbal Medicine, Bio-Resonance, Ozone-Therapy, and Colon Hydrotherapy. At a time when modern technology, environmental pollution, poor diet, and stress play a significant role in the degradation of health, a Naturopath’s ability to apply natural methods of healing is of considerable importance.
A collaborative practice model, which links doctors and nurses with new role for health coaches and other allied providers to provide more accessible and better care to patients.
A radical reform in the number, nature, and content of the subjects in which medical staff are trained to, as appropriate, embrace the best of the above
An openness to revise what we currently consider as acceptable evidence.
An educating of the public into the new medical paradigm