Monday 20 June 2011

Outcomes

Over the past few days I've been thinking hard about how the NHS has managed my case and how that might have been improved. Obviously I'm elated at the prospect of having surgical removal of the offending tissue. I was told right at the start, the first time I saw the oncologist, that surgery wasn't an option. So I never had any hope that it would be. I know full well that if you're going to beat this particular type of cancer, the best solution is the cut out the nasty bits. In fact my hubby asked about halfway through my chemo routine - whether surgery was possible. He was told again that it wasn’t.

The consultant had given me a figure for the rather short average life span for someone with my diagnosis. It was a little scary - no, that’s not the right word, because I’m not scared of dying. But it did shock me severely, because despite my pragmatism there’s something primaeval that engages when your life is threatened. You can’t help it. In fairness, he also told me that despite that average there were people who went on for several years. What he didn’t do was explain how it happened that they beat the average. And he didn’t hold out hope for surgery - in fact he positively denied its possibility.

Now I'm not advocating that the medical profession should tell lies, far from it. But I do wonder if they are shooting themselves in their feet by not sweetening bad news with more of a dose of extreme hope. So for instance, in my case: "this is the average life expectancy of someone in your state but if we can get the cancer to reduce substantially using chemotherapy, then you might be suitable for surgery".

The placebo effect has been proven to work - so why not in this situation? Surely a patient with some hope that they might eventually reach old age is going to respond far better to one with no hope. I am repeatedly told by those who know far more about cancer than I do that one's mental state is very important, if not the most important aspect in fighting this disorder. (I call it disorder because that's exactly what it is - cells' repair mechanism gone awry.) So why not use that placebo and talk up the possibilities of survival against the odds?

I’d also suggest that as well as drawing on the placebo effect, this new sunnyside culture could engage in the holistic treatment of patients too. So I don’t just mean offering - as some cancer treatment wards do - alternative therapies on the side but including those in the patients’ prescriptions along with dietary and spiritual advice.

There’s been quite a debate about doctors discussing religion with their patients recently. I really can’t see what is the problem with a GP - or any other medical professional for that matter - enquiring of a patient if they have any spiritual requirements. In fact, if it is not the GP who can diagnose an infliction brought about by a troubled soul, who is it? OK - blatant evangelising isn’t something I’d want on the NHS, whatever the creed or religion. But surely we should be dealing with the whole person and that might include their spirituality or lack of it. I’ve taken an holistic approach to my illness and I’ll testify that it works. If it works and the patient feels better and the ultimate outcome is better, then it cannot possibly be wrong.

We need a real Health Service revolution (forgive me if I’m repeating myself here - I seem to remember a similar tirade months back), not just a shuffling of papers. It needs a complete culture change whereby everyone looks on the bright side - staff and patients alike. We need to be treating the patient holistically and with the utmost optimism at all times. It’s that simple.

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