Posted by: Samir Dawlatly18 December 2014
Have you ever felt like a patient was asking you to prescribe them alternative housing or neighbours? I have.
Being asked to act as a social worker, and failing, left both me and my patient disappointed.
Feeling like you have let patients down is a major stress factors for GPs, and as covered recently, contributes to the huge wave of burnout that has inundated our profession.
Under the burnout ‘epidemic’, a new buzzword has emerged (thanks in part to the new grassroots GP group named after it).
‘Resilience’ could be defined as attitudes, behaviours and knowledge that help to prevent burnout and has three main aspects: promoting resilience in NHS systems, enabling doctors develop it themselves, and changing the way patients affect it.
Systems that seem opposed to promote resilience include tick-box exercises related to so-called patient care. Practices can try to ensure that their own systems, such as number of surgeries, sessions and administrative workload are tailored to their doctors.
Doctors have long been encouraged to develop their own resilience, through formal and informal mentorship and support or study groups.
But there is no one-size-fits-all solution.
Increasing resilience by changing patient behaviour is perhaps a new concept. But politicians, who don’t want to upset voters, will resist it - and so will doctors, for whom it is hardest to say ‘no’ to patients. After all, an ideal doctor is defined by virtue ethics as being kind, caring and non-judgemental.
Resilience, according to medical ethics, is a fair and just principles, as it ensures that GPs have a uniform way of dealing with unreasonable demands so that everyone is treated equally. And pandering to patient requests may not be any more healthy for them than it is for us. Patients are not customers and they are not always right. Sometime we have to practice non-maleficence (or, to use the layman’s terminology: protect patients from themselves).
Encouraging patients to develop their own resilience and coping mechanisms for conditions (which are, sometimes more social rather than medical) will eventually help and heal them.
If patients are encouraged to stop coming to the GP for unnecessary and unjustified demands, there would more opportunity to see patients with real medical needs - a greater benefit to the greater number (and a perfect example of utilitarianism).
Patient autonomy has probably been abused and overused as a concept, as many in power have encouraged patients to demand whatever they want. It tends to take precedence over other principles.
And now it is time to redress the balance. Ultimately, controlling unnecessary patient demand is not only justified, but essential to the resilience of general practice in the UK.
Dr Samir Dawlatly is a former secretary of the RCGP’s adolescent health group and a GP in Birmingham.