It’s time to stop pretending the health service can answer all of life’s ills, says Dr Katie Musgrave
What is our health service for? GPs have traditionally provided services to help ‘people who were sick or perceived themselves to be sick’. But what about lonely people? Teenagers worried about exams? Toddlers with difficult tantrums? Babies with colic? Women suffering from premenstrual mood swings?
Somewhere along the line, our society has medicalised normal life. A patient’s grief after the loss of a spouse is diagnosed as ‘bereavement reaction’, while an insecure youngster is diagnosed with ‘anxiety and depression’. Are people not allowed to be sad any more? Are children not allowed to have meltdowns? Is life not allowed to be shit sometimes?
We farm out our patients’ problems to the professionals, hoping that an hour on the phone having CBT might solve issues from a difficult childhood, a broken marriage or long-standing financial stresses. We hope that social prescribers might help address our broken, disconnected communities (they largely can’t). The professionals don’t have the answers, yet we keep referring.
Ever more people are given the emergency mental health number and urged to read online manuals on mental wellbeing and have a course of CBT. But are they not generally left feeling disappointed – that the ‘fix’ isn’t there – when they find they are gently fobbed off by a clinician who has as much to offer as a chocolate kettle?
With every passing year, it seems the health service is managing an increasing range of conditions, yet clearly not all are essential medical services. This would be fine, perhaps positive, in a system that was functioning well: where a heart attack or stroke was swiftly assessed and conveyed to an acute hospital for urgent treatment; where worrying symptoms of cancer were quickly attended to by a GP with the time to ask the important questions, undertake an appropriate examination and make a referral.
But the system isn’t functioning, is it? Our ambulance statistics are worsening year on year. Our emergency department waits are atrocious. Our early cancer detection rates are extremely poor by international standards. And yet, I regularly find time to explore the minutiae of a lady’s menopausal flushes. I often counsel anxious parents on sleep training, reflux and weaning. It is very common that a slightly upset child is brought to me, where my only intervention is to urge the parent to get the child to school, consider getting out of the house more or take up some hobbies.
In a war zone, which the NHS is rapidly emulating, we should not be discussing tantrums or mood swings. I know I will offend some by writing this. Still, if they were my mood swings, or my child’s tantrums, I would forgive the offence – if I knew my mother or father had fallen, broken a hip, and were lying on a bathroom floor for 10 hours.
The time for niceties has passed. There are no magic resources in the NHS. Every minute spent discussing a moody teenager is a minute less spent seeing a palliative patient. I know some of the teenagers with mood swings or ladies with night sweats will be emergencies, but most are not. And we usually have a reasonable inkling who could wait or be signposted elsewhere. Perhaps the non-essential aspects of our work need to have fees attached.
It would be nice to believe that the health service had the answer to all of life’s ills. It would be great to think we could help every sad, lonely or troubled person. But we can’t, and the longer we pretend we can, the longer we will see patients lying in agony waiting for ambulances or sitting at home on hold to their GP, scared witless that they won’t get through.
I want my patients to be able to access help when they need it. It is time to stop medicalising normal life and start being realistic about what the service can offer. More of the same is not an option, as increasing numbers of GPs walk away. But do any of our leaders have the courage to fix this?
Dr Musgrave is a GP in Devon and quality improvement fellow for the South West