Recommendations for improvements in care for people with multiple health problems
Two main issues came out of the interviews:
• the importance of good communication with health professionals and
• the need for better continuity of care (see ‘Continuity of care’) including more reviews / follow-up appointments and attention to patients’ emotional needs.
The need for better links between physical and mental health care is highlighted, specifically where people need psychological support following a diagnosis or major illness event. Other specific issues mentioned included a perceived need for better access to more accurate patient records, the importance of cleanliness in health facilities and a potential role for patient advocates. The importance of doctor and patient jointly prioritising also appears important.
Some doctors were criticised for the manner in which they communicated with patients. Graham suggested that time constraints mean that GPs may not take the time to listen to patients properly. As a result of courses he had undertaken through the Open University he believed that doctors who listen properly would get a lot more information out of their patients. Mohammed used to work in the health service and feels that many patients would be fearful of medical terminology and rather have things explained in “layman’s language”. Ronald was also critical of doctors who seemed not to listen properly to patient concerns, although he explained this state of affairs by the fact that GPs seem to be overworked. He saw this as a problem with the health system rather with individual doctors themselves. Other systems issues were raised by Angela, who was critical about the length of time it took to get psychological support after a stroke. She put this down to doctors not listening to her properly, which again pointed to communication issues. Her feelings were reinforced by apparent inaccuracies contained in her medical records. When asked how to improve services, Lottie again pointed to communication problems, doctors being seen as sometimes difficult to understand and not always open with patients. Andrew spoke about communication around treatment decision-making. Whilst patients are supposed to have “choice,” he believes most people expect the doctor to point to the correct treatment in a given scenario. He also reported being upset by being given too much medical information during the course of investigations. Specific issues raised by the people we spoke to included improvements to electronic patient records, cleanliness and the use of technology in patient-facing care. Lee and Leonard were quite happy with their care at the time of the interview and didn’t see a need for any improvement. Lee’s, “If it ain’t broke, don’t fix it” attitude is a reminder that change for change’s sake may not always be a good idea. After doctor-patient communication, the next main issue mentioned concerned the need for follow-ups and reviews. On occasion, these criticisms were centred on transition arrangements from hospital back to home. For example, people who had been in hospitals and rehabilitation units following a stroke found the levels of physiotherapy provision inadequate when they returned home. Andrew and Derrick both felt a lack of ongoing care for their heart conditions. The need for review and follow-ups also seemed to be tied to the expressed need from some people for psychological and emotional support, if only along the lines of a friendly human being taking interest in how they are getting on. However, GPs were seen as busy and overworked with large patient lists and limited appointment slots. Therefore, the likelihood of people feeling able to raise wider emotional issues appeared slim given the reported constraints on consultation time. Madelon found it difficult to get around and couldn’t understand why she was required to make her own way to the surgery at her age. Jean would like to have someone come in daily to help her wash and dress and make sure she eats and takes her medicines. As well as a need for reviews and follow-up, people also referred to the need for better continuity of care (seeing the same professionals over time), or joining up of different bits of health service provision. This forms the subject of a topic in itself - Continuity of care. Anne Y’s interview suggested that people might feel that seeing the same doctors was more important for one condition than for others, as she did in relation to epilepsy where the consequences were seen as far more serious for her than her other conditions (see also ‘Prioritising multiple health problems’). For Michael Y and his wife Pauline, the need for specialist epilepsy input appeared to outweigh all other aspects of care. Tammy felt that GPs needed to know more about specific conditions such as epilepsy, and she and others said they would like specialist doctors to be more sympathetic to everything that was going on in a person’s health and not just focus on managing a single condition. Fiona would like to see more communication between different hospital departments and health professionals. Another issue mentioned was better access to hospital care. Andrew said he had waited a long time for treatment after being diagnosed with a heart condition and Fiona was waiting a long time to see a specialist about the impacts of epilepsy on her pregnancy. Loraine would prefer not to have to travel 40 miles to see a specialist doctor nor to have to arrange the hospital transport herself.