The Healthcare Professional Will See You Now
In the good old days there were doctors, nurses, and patients. But then it was thought to be elitist that doctors were at the top of the tree, with nurses somewhere in the middle and patients at the bottom. So, in what used to be known as general practice, all members of the primary healthcare team, including the practice manager, receptionist, and geriatric social worker, now provide medical services together in partnership with the patient in a dance called ‘concordance’.
Incidentally, healthcare as one word does not appear in the 2007 edition of the Shorter Oxford English Dictionary. (Well, at least they don’t (yet) say HealthCare so let’s let this neologism pass.)
The relationship in which a doctor advised the patient, say, to take a pill three times a day after meals, used be regarded as one where the patient complied, or not, with the doctor’s instructions. But this was thought to be patronising and so instead there is meant to be a ‘partnership’ with the patient who is fully involved in all aspects of decision making, having had all possible side-effects of the proposed treatment explained to him or her, among much else.
And now in Britain there is talk of allowing Nurse Practitioners to accelerate the process of attrition of the functions of doctors by being allowed, after suitable training of course, to examine patients from the beginning, make diagnoses, and prescribe drugs.
In a discussion about whether nurses should take over more of the functions of general practitioners (British Medical Journal, 20 September 2008), one article is illustrated with a photograph titled ‘A nurse removes a mole from a patient’s back’. Great. Wonderful. Nurses can do difficult medical procedures like removing moles. And, by the way, aren’t moles those things which can sometimes turn into cancer? Presumably that is why it is being removed. She must be highly trained to do that. And I should jolly well hope so. But let’s look at the photo a little more closely.
For a start, the patient is sitting in a chair while the nurse operates upon her back in the region of the right shoulder blade. Not a good idea. Patients sometimes faint when having injections or their skin cut and fall to the floor. She should be lying down on an operating table. Secondly, it is remarkable that the nurse is wearing only one (bloodstained) glove, on her right hand. This is not safe for the patient or the nurse. Thirdly, in spite of modern sensible advice that practitioners should be ‘bare below the elbows’, the nurse in the picture is wearing a wedding ring and a wristwatch. Nasty germs could be lurking around the ring or the watch, including the dreaded MRSA ‘superbugs’. Fourthly, the nurse is literally operating in the dark – there is no proper illumination of the operation site with a lamp. Fifthly…all right, I think you get the point.
I don’t know about you, but if I had something wrong with me or was just worried about my health, I would want to consult someone who was medically qualified. And as for this new-fangled notion of having a relationship with patients of ‘concordance’, which the SOED defines as Agreement or harmonious relations between persons, surely this is what any self-respecting doctor has always been aiming to achieve anyway.
©Gabriel Symonds 2010