Give us the time to help people place their health bets
Dr Shaba Nabi
I’m writing this blog after screaming at the telly as the Public Health England’s chief executive told us we need to ‘know our numbers’. He meant our cholesterol and blood pressure readings, but other numbers are far more important.
The numbers people really need to know are their odds of having a heart attack or a stroke – and this is an area where GPs genuinely are best placed. So if the Government wants to reduce health spend and improve outcomes, it needs to value the GP consultation more.
Effective consulting needs to place the person at the heart of decision making – to give them enough evidenced-based information to steer their own health journey.
But let’s reflect for a minute on how we do this. We enter data into computers, which immediately ping up messages about starting medications, ruling out sepsis or fast-tracking an urgent cancer referral. We dare not ignore these messages, as once triggered, they are immortalised in the notes, and could come back to bite us in court.
But what do all these guidelines mean to individuals? They don’t care that lowering average blood pressure will reduce stroke incidence in a particular population. They want to know how much they themselves will benefit (or be harmed) by a treatment, screening or intervention. They need to reflect on their one in 100 chance of preventing a heart attack, in exchange for the one in 10 chance of tiredness or swollen ankles with another antihypertensive. They need to know if five fewer trips to the bathroom per week is worth the dizziness and dry mouth an anticholinergic may bring. And most importantly, they need to be aware of the psychological impact of being turned into a patient through lowered disease thresholds and indiscriminate screening.
What we all really want to know is, what are our health gambling odds?
How do we facilitate their decisions? Sadly, we’re lacking in this knowledge ourselves. My trainees are well versed in NICE treatment thresholds, but none of us is confident to inform someone of their individual risk. What we all really want to know is, what are our health gambling odds? If I don’t take this statin, how much more likely am I to have a heart attack or a stroke? If I undergo back surgery, what is the likelihood of a pain-free existence? And if I enter a breast screening programme, what are my chances of being diagnosed with a cancer that would never have killed me?
What we need to reduce overdiagnosis and overtreatment is a health betting shop where we can clearly see our odds and place our bets accordingly. Instead of being bombarded with yet more guidelines, we need an intelligence platform where people can confidently select their treatment choices according to their personal values.
But most of all, we need longer consultations. If GPs had the time to practise shared decision making, we could reduce much of the low-value activity that costs the NHS millions. Urgent investment is required to enable longer consultations, and it is regrettable that this has not been mandated in the new GP contract.
People would not be harmed, and doctors would be far more satisfied and less burnt out. It really is that simple.
Dr Shaba Nabi is a GP trainer in Bristol. Read more Dr Nabi’s blogs online at pulsetoday.co.uk/nabi