Flipping the script on the ‘doctor knows best’ model | Dr David Payton

Self Care Week 2017

Dr David Payton explains how care and support planning can help people with long-term conditions to feel more in control and improve their outcomes.

Thirty per cent of our population have at least one long-term condition, using up to 70 per cent of NHS resources as well as the vast majority of social care funding. 

As doctors, we tend to concentrate on each individual condition, forgetting that the majority of people with a long-term condition not only have to live with their condition day in and day out but will also generally have more than one condition. The biggest single long-term condition is multiple-morbidity. 

The traditional biomedical approach is simply not working – can we be surprised? People are busy with competing priorities, and for 99.9 per cent, learning to deal with their long-term conditions while getting on with their lives.

What is care and support planning?

Care and support planning is the social model in which people with long-term conditions are helped to work out what is important to them and look for solutions, rather than focusing on biomedical metrics.

The principles behind it are simple. 

  • It is proactive. 
  • It focuses on people’s strengths rather than their deficits. 
  • It is guided by “what is important to you”.
  • It is designed to enable people to understand and feel more in control of their conditions.

Embedded into the process is support for people to prepare for a conversation with a health professional, a care coordinator or community navigator with access to what is unfortunately called ‘social prescribing’ but should be seen more as peer support.

Is this all just pseudo psychobabble or does it really have an impact on the harder biomedical metrics, including hospital admission, HbA1C and lipid control? 

It does. And there is now work suggesting that when people feel more in control (sometimes referred to as patient activation) outcomes improve.

So what’s the link with Self-Care Week?

Self Care Week, which runs from 13-19 November, is a Self Care Forum-organised initiative which aims to raise awareness of how people can look after their own health better with supported help. We hope people-facing organisations, in particular NHS organisations, will use it to introduce self-care strategies to support and empower people. 

Figure 1 in David Payton's blog, showing Kaiser pyramid

Care and support planning is an ideal model to launch in Self-Care Week. As you can see from the well-known Kaiser pyramid above, there is a common thread between self-care, shared decision-making and care and support planning; a thread that pulls us away from the paternalistic ‘doctor knows best’ medical model which encourages dependency to one which builds more empowering shared decision-making relationships.

A thread that challenges us professionals to review our cultural approach to working with those people (I try to avoid the word patients) with long-term conditions. 

Does this invalidate the medical model? Absolutely not! There will always be a place for the reactive biomedical model, but perhaps it might be easier to see the two as ends of a spectrum.

David Payton figure 2 depicting the biomedical spectrum

The real test for the professional is to find the right synthesis between the two while trying to shift, where possible, the consultation to the right.

Dr David Paynton is a GP and member of the Self Care Forum board.

Find out more

For further information about Self Care Week is available on the Self Care Forum website or email selfcare@selfcareforum.org

For more information on care and support planning go to the RCGP website

Self Care Week web banner 2017

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