Prioritising multiple health problems
One of the main ways in which people prioritise their health conditions is according to whether they are successfully controlled by treatment (or self-management) or not. Pat prioritised her IBS (irritable bowel syndrome) as outings needed to be planned around access to toilets. Many people with epilepsy prioritised this condition, for a variety of reasons. Tammy said she did so because seizures come without warning. Loraine prioritised her epilepsy as it affects “everything else.” Lottie was concerned about the impact her epilepsy could have on her diabetes control. Tony prioritised his epilepsy as he thought it had the capacity to cause serious harm, whereas asthma was seen as an annoyance. Anne Y said that epilepsy is more annoying than asthma and needs more explanation for friends and family members. Some health conditions are more serious than others and the consequences vary for individuals. For example, one person’s asthma may result in nothing more than a rasping noise when they breathe, whereas another’s may require night time oxygen and repeated hospitalisation. People prioritised their conditions according to the different effects they had on them. Leonard found that coeliac disease had the biggest impact as it affected his diet. Barry’s stroke had the biggest impact on his life, partly because it had resulted in changes to his personality. Nigel prioritised his diabetes because if it was not well controlled it could impact on his other conditions. In Jean’s case, she and her doctor seem to agree over what her health priorities are. However, this was not the case for other people, who felt that the condition they were getting the most help with from the NHS was not necessarily the issue that they needed the most help with. This situation seemed to partly reflect the specialist nature of health service organisation, and the division between health and social care. Fiona was getting lots of help for her diabetes since she had become pregnant, but she wanted more help with her epilepsy. Angela was getting most help for her asthma, but she wanted more support from her GP following a stroke. However, this was not seen as falling within her GP’s role. Having multiple health conditions is seen to create extra work for both doctors and patients within a system that is set up primarily to treat single problems in medical specialties. When people see lots of different health professionals for different reasons, it is not always clear who is in overall charge (see also, ‘Continuity of care’). Whilst GPs are often the ones required to maintain an overview, they are not specialists in any single condition. They are also seen as overworked, which can lead people to feel guilty about consulting them too much. Decisions about what to prioritise are made in the light of these organisational issues. In extreme cases, i.e. where somebody has a large number of conditions and/or is taking many tablets (see ‘Dealing with multiple medicines’), it is not always clear whether a symptom is caused by an illness, is a side effect of a medication, or is the result of an interaction between one disease and a medication taken for another (see also, ‘Interaction between different symptoms, conditions and medicines’). In these circumstances it is very difficult for someone to prioritise, as it is not clear what is causing the problem of major concern. Whilst the focus of this topic has been on medical and self-management in multiple health conditions, people also have to prioritise issues and activities in their everyday lives. For example, it was evident in Jean’s account (see above) that an important priority for her is the ability to go for walks. Sometimes, people find that they can adapt to the circumstances brought by multiple health problems. For others, changes in their personal or family lives bring a new motivation to try to manage their health conditions better. Priorities are not fixed. They change over time.