Page last updated at 05:22 GMT, Wednesday, 21 January 2009

Personal touch lost in 'pass-the-patient'

John Black
VIEWPOINT
John Black
President, Royal College of Surgeons

Surgeons
It's likely a patient will see a number of doctors during their treatment

NHS patients can now choose where to have an operation and targets say how quickly procedures and tests should be carried out.

But in this week's Scrubbing Up health column, John Black, president of the Royal College of Surgeons, says the doctor-patient relationship has been damaged and argues that a single consultant should once again oversee a patient's care.

No matter how routine the operation, learning that you need surgery is an unsettling and pivotal moment in anyone's life and requires confidence in the abilities of those caring for you.

A much underestimated and unmeasured factor in healthcare in this country is the importance of the rapport that develops between doctor and patient.

This trust is now being eroded by a system that has reduced healthcare to a factory production line where over-reliance on numerical targets and computerisation has broken down care into a series of procedures.

I believe this is driving a wedge between patients and doctors in a way that is becoming detrimental to patient care.

'Cord cut'

Until recently, your GP would refer you to a single consultant who would then see you through the whole process of your care, from initial consultation to final discharge.

GPs needed to maintain direct professional relationships with local hospital doctors to be able to select the right consultant for each patient, based not just on the type of operation and technical competence, but also on personalities.

Medical consultation
When you are only part of a production line, it becomes ever harder for the healthcare professional to deal with patients as human beings

However, this cord between GPs and surgeons has been cut by the computerised "choose & book" system, which purports to offer greater patient choice but which has had the opposite effect.

You may now select the hospital based on sets of centrally gathered statistical measurements, rather than the right doctor for you with professional advice and support from your GP.

How many patients know enough about the health service to make a really informed choice?

I believe that patients genuinely welcome advice and input from their family doctor on which specialist may be right for them as an individual - a proper complex person not a statistic.

A to B

Because of the target culture, continuity of care has been severely compromised.

You might be seen initially by Consultant A, come back for your results to see Consultant B, go on to a common waiting list and then have your actual operation done by Consultant C, whom you might meet for the first time on the morning of your operation.

You may well be sent home the following day by Consultant D and if you are fortunate enough to have a follow up consultation, you may be seen by consultant E.

John Black
It should again be the norm that patients are referred to an individual consultant who will be responsible for their care

This provides numerous opportunities for mistakes to be made, and it is deeply unsettling for the patient to be handed over time and again at every stage to a new doctor.

This is also demoralising for clinicians. For me, and other surgeons, the great joy of the job is in seeing a real positive difference to someone's life.

When you are only part of a production line, it becomes ever harder for the healthcare professional to deal with patients as human beings.

Surgeons losing control of their waiting lists has also taken away the flexibility to make appropriate professional judgements about which patients are in greatest need and should be dealt with sooner.

Another factor is that surgeons gauge their own ability on the outcomes achieved for their patients. If you never see them again, how can you know how you are doing?

It should again be the norm that patients are referred to an individual consultant who will be responsible for their care throughout the clinical episode.

Using the latest technology to increase the efficiency of the health service and measure how patients' lives are improved is vital.

But this must be sensitive to the individual patient and must retain personal professional judgement.

The current system in the NHS is forcing patients and doctors apart and I believe the delivery of care is poorer without those personal relationships.


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