As thoughts are dragged, by politicians and the media, towards membership of the European Union I am struggling with a lack of understanding of the detail and a realisation that it is not merely an economic analysis. There are many complex questions including a moral one, for example, what effect would leaving have on other countries?
It is very tempting to stick with the status quo. After all, we know what it’s like to be ‘in’ and can only speculate what it’s like to be ‘out’. This very human instinct to resist change unless one is significantly dissatisfied with the status quo may be one of the factors holding back more rapid evolution of health services. And, of course, hierarchy, professional culture and, perhaps, the personality of those of us attracted to ‘caring’ for others.
There are very established structures in the healthcare professions. Commonly, those that hold the most power and influence tend to have been around longer and may be conservative; that is they may wish to protect the ‘system’ and perpetuate traditions.
I have been an MSK physiotherapist for over 30 years and, compared with many other sectors (non-health), there has been relatively little change, at least from a patient experience perspective. Different clinical thinking (memories of Cyriax, Mulligan, McConnell, traction electrotherapy, exercise!) has evolved, which is healthy, but much has not when it comes to the patient ‘journey’. Many processes still involve a doctor’s referral, are technology light, require travelling to a hospital, are too specialist centred/not holistic, etc etc. A patient’s understanding of how to manage their problems, feeling confident and facilitated to comply with their self-management programme has to be the most important thing we do.
I don’t believe we have moved on in these areas as much as we should. I expect the expert clinicians in the profession to push forward on improving clinical outcomes and to continue to develop better interventions and ways of improving outcomes.
But all the other ‘stuff’, to improve the patient’s experience – who’s focusing on that?