Introduction by Professor the Baroness Hollins
Let's get uncomfortable.
I have to admit that it’s not nice to feel uncomfortable but I’ve noticed you learn a lot about yourself and about your patients when you have your boundaries pushed beyond what you’re used to.
In my career, the times I've learned the most are when I've found myself with people who have tested my comfort zone. Let's face it, as a doctor you can go through some really tough situations with patients and it's not always easy to talk about the experience of being uncomfortable. Isn't it usually when the patient is trying to tell you something that can't be put easily into words?
Discomfort helps us learn
How discomfort could be a real chance for professional learning and development was one of the key points that arose from a series of seminars in the House of Lords I ran during my presidency of the BMA. The seminars had the broad theme of improving the quality of healthcare for some particularly vulnerable or overlooked groups, and brought together figures from government, commissioners, educators, service users and healthcare professionals. Discussion included whether practical training delivered in partnership with people with learning disabilities, people with mental illness or survivors of abuse could help doctors manage their discomfort better when they find their patients behaving in ways they are not familiar with.
Series of seminars
I chose improving the quality of healthcare for vulnerable groups as the theme of my seminars for a number of reasons. Historically, lots of attention has been given towards debate on NHS structure and processes but much less on quality. This seems to be changing somewhat, as recently, Winterbourne View and Mid Staffs have brought into sharp focus serious worries about healthcare especially for more vulnerable people. These were dreadful examples of poor care that should never have occurred and lessons are being learned.
I wanted to put the spotlight on a range of issues faced by people whose needs are often overlooked. My seminars covered four topics - the response to the Winterbourne View Hospital scandal, delays amongst doctors in recognising and responding to domestic abuse, the offender health pathway with a focus on the levels of learning difficulties amongst prisoners, and finally the provision of physical healthcare for those with mental health problems and learning disabilities.
Throughout these seminars, I raised the question, what can doctors do? What the topics have in common is that they raise human rights and competency issues for the clinical practice of all doctors in clinical practice. They are not just the business of specialists.
Getting healthcare right for every patient
My belief is that we should use that state of discomfort to address our training and support needs to help us get the quality of healthcare right for every patient. But it’s also about providing leadership in managing difficult situations and in making the reasonable adjustments each patient may need as required by the Equality Act. Knowing that your patient or a prisoner can't read should prompt you to adapt your interview style and the way you provide health information. Recognising the risk of diagnostic overshadowing should prompt you to enquire whether you have investigated and treated this patient as well as any other. Lowering your threshold for asking about abuse could improve the present statistic – that victims of domestic abuse seek medical help more than 20 times before their abuse is recognised. And don't forget carer abuse.