This winter promises to be one of the toughest in living memory for all of us, patients and doctors alike.
Against the backdrop of a deepening cost-of-living crisis, the colder months are likely to place further strain on us all, in a number of ways.
Whether it is through the need to heat our homes and health service amid spiralling energy costs, or because of a spike in seasonal illnesses such as flu compounded by the lingering presence of COVID-19, individuals, families and the NHS will face enormous pressure.
Indeed, the backlog of care generated by the unprecedented challenge of the pandemic means thousands of GPs and hospital trusts continue to operate at the absolute limits of their capacities and capabilities.
Add to these the continuing and growing levels of health inequality in our society, an issue the BMA is seeking to highlight as part of a new wide-ranging campaign launching this month.
It is with this in mind that this week, 14 to 20 November, we see the whole of the UK observe self-care week. The emphasis of this year’s event is on promoting the exercise of self-care not just during times of illness or injury, but for life.
Overseen by the Self-care Forum since 2011, the aim of the week is to help embed support for self-care ‘across communities, families and generations’ through the collaborative efforts of hundreds of organisations.
As doctors, the concept of self-care and how we approach it when engaging with our patients can sometimes feel a tricky one.
We also recognise how recent developments in technology, media and entertainment have often promoted a rapid ‘quick-fix’ approach to daily life in society. This can often be unhelpful to conversations around self-care, with the ‘Amazon Prime’ effect on our society having helped to foster sometimes unrealistic expectations about what health professionals and the NHS should be capable of.
What do we mean by ‘self-care’?
Before we start any conversation with a patient, it is important to reflect ourselves on the fact that there are two forms of self-care: that which is practised by an individual in response to illness, and the more holistic idea of self-care for life, as a preventive measure against future ill-health.
This distinction is an important consideration when offering advice about the ways in which people can take steps to take care of themselves in either the short- or long-term.
It also allows us to reframe within a patient’s mind the way they view their own healthcare decisions. Getting a flu vaccination, for example, need not be seen as a ‘take or leave’ choice, but as an active step towards self-care, one that will benefit the vaccinated individual, their community and the health service.
Motivating through listening
Rather than leave patients feeling like they are being ‘fobbed off’, it is critical that we couch our conversations sensitively and considerately, and frame self-care around the idea of empowerment and respect by helping people to become more informed and more in control of their wellbeing.
One strategy that has shown to be effective in this regard is that of motivational interviewing. This approach to engaging with patients recognises that simply instructing someone to quit smoking or reduce their BMI can be counterproductive.
Instead, it places an emphasis on listening and taking a non-judgemental and supportive approach to encourage voluntary changes in behaviour and greater efforts towards self-care by the patient.
Many patients understand the enormous challenges facing their health service and many also recognise that there are likely to be people within their communities who are more vulnerable than themselves.
An absence of self-care therefore is not necessarily because of unwillingness on a particular individual’s behalf, but because the patient does not have access to the information and knowledge that will allow them to achieve this.
By appropriately and effectively signposting patients to the existence of other forms of support and information, such as pharmacies or the NHS Choices website, doctors can make an important difference in helping patients practise self-care and manage bouts of self-limiting illness.
Where a patient concerned about their health does attend your surgery, ensuring they do not leave ‘empty handed’ is also an important means for promoting self-care.
Whether it is something as simple as a medical leaflet, a link to further information online or a referral to the practice’s health adviser, there are many simple ways in which we can provide a prescription for self-care.
Perhaps the most important factor in promoting self-care, however, is taking a consistent approach in what we advise our patients.
Differing guidance or advice, particularly when it comes from the same source, can understandably result in confusion and increase uncertainty when it comes to managing health.
Maintaining a clear and consistent approach on messaging at all times can sometimes prove challenging but are critical in encouraging greater uptake of self-care.
Kieran Sharrock is BMA GPs committee England deputy chair