Archive for January 2009

When researching issues relating to medication compliance, to ensure I capture all relevant studies, I find myself having to type the following into the relevant search engine: “compliance OR adherence OR concordance“. I find this incredibly frustrating, and not just because it takes me a long time. Supposedly, the evolution of the concept of compliance to adherence to concordance is the semantic equivalent of kicking paternalistic healthcare provision squarely in the balls. But is it? Can a lexiconic adjustment really represent a tangible step forward in patient empowerment? Or, as I suspect, is it a ploy to suggest progress where there is little?

Answers on the back of a postcard, please.

So, why this entry now? I was reminded of my frustration at this issue by that I experienced in response to the government’s long-expected and recently-announced decision to reclassify cannabis as a Class B drug. A monumental U-turn, that flies in the face of expert advice. Could the time, effort, and money spent on tinkering with this (more-or-less) arbitrary classification not be put to more useful ends, like a public health campaign highlighting the dangers associated with cannabis use? Don’t bother with the postcards, the answer is: yes.

When I was nine, I decided that I was going to be a doctor.

When I was twenty four, I decided that I wasn’t.

So then I was faced with the difficult and somewhat unexpected decision of what to do instead. With a background in medicine, my recruitment consultant gently nudged me away from my plan to advertise cars, and I found myself working for a medical education agency. It was the right move to stay in healthcare, not only is it my area of expertise, more importantly it is what I care about.

Having worked on the wards, I have seen the miscommunication and sometimes complete lack of communication that occurs between patients and their doctors. I have irritated numerous consultants with questions on their patients’ feelings and opinions. It is the great privilege of the medical student to have the time to talk about such things! (Perhaps partially as a disguise for our limited medical knowledge)

But on a serious note, I absolutely believe in the importance of having a patient-centered approach to medicine. So when I met the team at Hive, by unexpected fortune, I couldn’t have imagined a more perfect place for me to be.

I’ve been here for 6 days now. So far, so good.

The NHS constitution was today unveiled, two years after it was first suggested. The document sets out the rights and responsibilities of the patient. Critics have been quick to speak out against the constitution, claiming that it tells us nothing new.

The content itself may not be new – but the message it sends certainly is. Information on patients’ rights is of little value if it is hard to find and hard to read. This constitution aims to provide a ‘one stop shop’, where patients and NHS staff can easily access and understand the rights and responsibilities of the patient. It provides a foundation for true patient empowerment, by increasing the transparency of the system, and thus its accountability. It is an exciting step away from the traditional paternalistic doctor-patient relationship, towards a more sustainable and mutually satisfying partnership model.

But as Mike Sobanja of the NHS alliance points out “If it remains a piece of paper, it won’t help – action not words will bring it alive.”

Hear for yourself -  The R4 Today Programme with Alan Johnson.

I’ve worked on a host of POM to P switches, most now launched, some not and some still to come. This article indicates very well the inate disconnect I believe that the medical fraternity has with pharmacy. I think it also clearly highlights the relationship Doctors think people have with their health and with them as Doctors.

Over 70% of doctors oppose the switch of Flomax (tamsulosin). The vast majority saying that there is a risk of pharmacists missing underlying issues. I passionately believe that Pharmacy have a critical role to play in providing care on the high street. Having done much work with pharamcists as a group, I also know that they themselves worry about missed or underdiagnosis.

The reality is there are huge sways of the population who do not present to Drs, who do not recognise symptoms as problematic until pointed out to them and are either in denial or too scared to present to a Dr. Men in particular are great avoiders. Switch provides an opportunity for patients to enter the healthcare system in an accessible, non-scary and anonymous way. If I were a betting man I suspect brands like Flomax being available over-the-counter will encourage them to open a dialogue with healthcare professionals, recognise that actually what they thought was normal is not, and who knows get seen earlier by GPs not later when Pharmacy refers on. Certainly I know from previous switches that there has been an increase in prescriptions, suggesting more patients presenting in surgery too. I think Drs should be asking themselves some critical questions such as “who do we trust more, Pharmacists or patients?” “Do I welcome that they are in the system somewhere or nowhere?” Its time to accept patients decide and the more access points to health they have, the more knowledge we can give them, the better for all.

Check out WPP Group’s Grey Amsterdam TV ad for Lacatacyd, a female hygiene brand sold in the Netherlands. What do you think? We’re a mixture of delighted laughter and disgusted leg-crossing over here.

Now, this is provocation amongst British people. Will the ad raise smiles and eyebrows amongst the Dutch? I can’t see such an ad making it past the UK boardroom, but regardless of cultural audience, it surely required guts from the pharmaceutical company involved. (A little less of a gamble, perhaps, if it was intended not for the mainstream but as the viral it’s become.)  

Whatever the case, I feel vaguely duped by the message. Like I’m being dazzled with novelty so that I don’t think to question the strapline “Protect yourself everyday”.

The brief was to “overcome the perception among women in the Netherlands that Lacatacyd is for problems only”. I can’t find any data on this product and I don’t know what its active is.

Say what you like about “feminine cleansers” – unnecessary/ exploitative some say. It’s a simple thing: some people wash their face with soap and water, others buy facewash.

But protection? From what? Every day? I’m not sure whether to feel disappointed or personally alarmed.

Off to do some research.

I am happy to say that I have completed my first week at Hive, and have survived in tact. I am feeling thoroughly looked after, and already feel like part of the furniture.*

One of the take-home sentiments of the week, for me, is the obvious commitment of the team to a patient-centred approach to healthcare communications.

In my previous role, at a national mental health charity, I had encountered more than my fair share of hollow claims to patient-centredness. This easily-employed jargon masking the fact that the patient was being ignored when developing communications, or that communications were developed on an inaccurate (and invariably patronising) idea of who the patient is, what they need, and what they want. It is for this reason that I breathed a sigh of relief when it became apparent to me that the team’s claim to patient-centredness is genuine – they take time to really understand the patient, and that the patient is built into all that they do.

 For me, this approach is an invaluable tool in reconciling the oft-cited conflict of interests between patients, payers and prescribers, and Pharma. Patient-centredness translates into patient-engagement, which ultimately confers demonstrable benefits to each of these parties. It should be cherished where it occurs, and encouraged where it does not.

* Speaking of furniture, just don’t ask what happened to Debbie’s chair. All I can say is, if you have any office furniture that needs testing to destruction, you should give her a call.

I have to admit that the first week back from Christmas has never been one that fills me with fun and enthusiasm. It’s too cold, too busy, and I need to wean myself off of days spent eating, and in the fold of family life.  I find myself needing some inspiration this early in the year.  (Ian thinks this is soft needy nonsense. Bless him)