For Parents & Carers
For Health Professionals
This page is specifically devoted to health professionals be they doctors, nurses, health care assistants, school nurses, or workers in secondary care. Feel free to look at this page and provide feedback even if you are not a healthcare professional. However, the content is probably best understood by health professionals.
- The Context
- The Facts4Life Response
Facts4Life has been developed against a background of growing crisis within the medical world. Political and social pressures have created a context in which there are ever increasing expectations made on practitioners. In so many cases, the burden of responsibility now weighs upon those in primary and secondary care to ‘fix’ patients, to make good the shortfall in the individual’s perception of how they should be feeling, often through medical or surgical intervention. We aim to challenge this context in three significant areas:
(1) Responsibility and shared decision-making
It is no surprise that patient expectations increase in the light of improved recovery rates from serious illness, the ability to function well despite chronic disease and the greater accessibility of information through the use of Google doctor and other online oracles.
The question is: How do we best give people the ability to make sensible decisions about their health? At the moment, this tends to be addressed downstream by complicated ways of shared decision-making. SDM between patients and health professionals in primary care or secondary care settings is supposed to ensure that the patient is in the correct mental space to make a decision. The effect can sometimes be to bamboozle the patient with information. It jars with some patients who have come specifically to see their doctor for guidance. The idea of meaningful SDM seems ridiculous, if patients have no insight into the way doctors think.
(2) The perfection agenda
It is a paradox that in spite of the evidence that we are becoming healthier by most measures, there remains a growing perception of the threat of illness. This I call the wellness or ‘perfection agenda’. It is the idea, promoted by advertising and a lot of traditional and new media, that we should have a perfect body and/or perfect health. It is also the consumerist idea that if we don’t have these things then we should be able to do something about it. If we don’t have a perfectly functioning body, we are likely to feel this constitutes an illness and that health professionals should make us better and often immediately. The medical profession has unwittingly connived with this demand or certainly failed to challenge this perception.
(3) The under use of lifestyle interventions and the need for instant solutions
The drivers that promote the use of drugs or surgery as an intervention, when lifestyle changes would be more effective, are many and various. They are justified at times intellectually and financially, supported on grounds of greater professional efficiency and reinforced within training. However, in the 30 years I have been practising medicine I have seen a wholesale change in the attitude towards health and lifestyle. For example, people with osteoarthritis used to be told to rest as much as possible and now are encouraged to lose weight and exercise. There are virtually no conditions where exercise is now thought to be harmful. Despite this change in attitude, the pressures on time, both within the consultation and more widely within our culture, mean that drugs or surgery are the preferred solution to the problem on both sides. In this context it is often extremely difficult to hand back the responsibility to the patient and encourage lifestyle change. This is clearly a very complex issue. But it is also clear that the NHS as an organisation has made an implicit contract with the population to take responsibility for the problem and provide the instant cure, even if this is not in the patient’s long-term interest.
The Facts4Life Response
We begin by responding to the interest of young people in their own bodies, their health and their experience of illness, through the use of educational materials in the classroom. We are also extending this dialogue to the families and wider community, including medical practitioners in primary care.
We seek to influence the perceptions that children have about illness from an early age. We also need to give them opportunity at an appropriate level to learn about some of the important facts and approaches that are addressed at medical school so that they can understand the way that we health professionals think about illness, attitudes to risk and the determinants of health. Many quite complex subjects can be explained with the help of analogies or metaphors – I’m sure many of you practise this. We are able to reassure children that illness is, by and large, another challenge that they can meet in the same way that they meet educational challenges that are presented to them
We are building partnerships with GPs and sharing our approach and the language of our materials with practices that are working within the communities of Facts4Life schools. One of the central aims of Facts4Life is to improve the dialogue between health professionals and patients so that people feel they have better ownership of their own health. Ultimately, we see Facts4Life as altering the nature of this dialogue so that in time patients will feel that they have a collaborative, rather than hierarchical, relationship with the healthcare professional.
By providing opportunities in the classroom for young people to explore the wide range of normality in their health experience and in the experience of others, we can begin to address the ‘perfection agenda’ and the unattainable expectations it brings. The central idea within the resources of ‘riding the ups and downs’ brings a dose of realism to the notion that wellness is a constant that can be provided by others.
Through the development of a sense of meaningful responsibility for health, lifestyle interventions become an accepted part of the dialogue between patient and GP. The nature of the interaction moves from prescription to one in which there is a more open exchange of information.
Dr Hugh van’t Hoff (GP and Director)