So we have a new NHS buzz term ‘patient engagement.Well, The Kings Fund says,
‘The role of the patient is no longer as a passive recipient of care. Nowadays doctors are expected to engage patients in their own health, care and treatment. There are also a number of initiatives to encourage patient involvement in the design, planning and delivery of health services.’
So let’s see what my own experience was in 2010, albeit before the new hype started, around the phrase ‘patient engagement.’
Well, I was very much a passive recipient of life-saving care in ICU, although I was mistakenly conscious. Sporadically, ‘my nice nurses’, would often make me aware of the vast array of medical procedures I had no choice but to endure.
‘Engagement’ was nigh-on none-existent at a time when I was wrongly considered semi-conscious (for two weeks after my stroke), though in reality I was fully conscious the after week from emerging from my medically induced coma!
I put it down to that either I became conscious far sooner than my Glasgow Coma Scale results implied or the results were interpreted inaccurately. It is fair to say that many of my nurses – and all my many consultants – were not remotely proficient or confident or willing to use of my rudimentary letter board and life enhancing life line at the time.
I still remember the heart stopping moment (literally) when my body reacted badly (and in rare cases) to the dried blood being cleaned off my new PEG by an over-zealous ICU sister.
I experienced a painful out-of-body-experience, that rendered that ‘said’ sister a quivering, emotional wreck at the foot of my bed. I remember her being consoled by the other staff, whilst I lay physically paralysed and traumatised in fear and incredibly vulnerable and lonely as my life literally flashed before my eyes.
(My husband, who was visiting at the time, thought the ‘crash team alarm’ was for another patient and assumed his ‘visiting time’ delay was because I’d soiled my ‘nappy’.)
Why also didn’t anyone engage with me as to why my beloved Earl Grey tea was on and then off limits? If they’d said,
‘Kate, if we give you tea and 35 mls goes down the wrong way into your lungs, you will drown, end of.’
But no, they used technical medical terminology to a lay person saying,
‘Kate, you can’t have your tea because you will silently aspirate.’
Did you know what ‘silent aspiration’ was before stroke?
I wondered whether my traumatic (and post traumatic stress disorder) could have been reduced if someone had explained to me, or my family, that I was likely to suffer with extremely vivid and distressing hallucinations.
Hallucinations that were like awake-nightmares and which were not real, although convinced me of their reality. I still remember a recurring one, where after my loved-ones left for the evening, a particular nurse – I hated – would slowly start poisoning me with a fatal brown, graphite drip. You see, I couldn’t do anything so the way I saw it in my blinkered terrified world was that why on earth would I be worth keeping alive?
Now, I know there is no such thing as a graphite drip and the brown fluid, flushed down my cannula, was to treat my severe constipation at the time.
Fast forward to rehabilitation, and my therapists became very goal-centred, well after a few months anyway. Up until then, they had just been giving me passive or ‘no hope’ therapy. My later improvements were down to pure unadulterated anger, self-belief and bloody hard work (with the help of my therapists) Proudly, my favourite nurse Oliver recently said, ‘that I actually drove my therapists far harder than they ever drove me!’
I was a former 70 mile a week fell runner after all and as a deeply committed full-on mother to 9, 8 and 6 year olds. I was suffering from severe separation anxiety that no one bothered to ask about. I mean let us see, are there really any mothers out there that can imagine not being able to comfort your distraught kids in a crisis (when they’ve seen you lifeless and grey wheeled from home and into an ambulance), or hugging them like it’s the last ever hug before you die or even being able to say, ‘it’ll be alright,’ or just saying ‘I love you?’
My whole recovery was based upon being home as a participatory mother to my kids, end of. My running obsession, if they bothered to ask me, gave me the work ethic/work rate and the drive to achieve my ambitious goals.
Instead, the medics tried actively dampen or lower my goals constantly. My goals at the time they were to ‘return home as a proper full-on mum’ and to ‘run again’. Perhaps, they thought I was in denial? Well, yes, they were damn right, but that didn’t mean I didn’t have real ambitious goals to chase at the same time!
There were times when my opinions could have been canvased and views painstakingly gathered, so I could have been engaged with them about my continence training, or why my bowel movements on the PEG, were so embarrassingly explosive etc.
I couldn’t speak, yes, but I could have been given explanations of my treatment plans and communicated my basic demands. I never knew how and when my physio or swallow exercises would eventually lead to a certain level of independence for me.
Instead during therapy, I would often be treated to the gossip from the therapists (or nurses) about their exciting though ‘normal’ things they did over the weekend, or hearing who was recently pregnant on the ward or which consultants they despised and why.
I often wondered if my therapists would pick up on my non-verbal clues about my distress over my excessive saliva production – and inadequate saliva management. If they had, then they may have been able to anticipate my anxieties and understand when I hand to gesture withy eyes ‘time-out’ from my precious rehab session?
So I wonder, was there insufficient GP, therapist and consultant training on them being able to assess patients real views, values, capacity or their willingness to share?
Indeed , do the length of consultations prevent proper patient engagement?
Does the referral system in the UK reduce a patients’ treatment options and discussions? Are there enough administrative monitoring systems in the NHS for thorough patient engagement in practice? What, if any, are the barriers preventing therapists engaging properly with patients? Furthermore, how well do we evaluate improved (or not) patient outcomes after a patient engagement process?
I’m interested in your answers therefore, our next Tweetchat questions on 14th April at 16.00 will be on:
T1. Do you think stroke patients, or their carers, want to be engaged in managing their own health?
T2. What may discourage patients or their carers, being engaged?
T3. What skills or resources do patients or their carers need to have to be engaged in their health? Are those resources accessible?
T4. What barriers prevent therapists engaging with patients?
T5. How do we evaluate how well outcomes improve after engagement?
I do feel very strongly that proper patient engagement can and should, improve patient outcomes, but I do fear this new NHS buzz term will be nothing more than a feel good exercise.
P.S I did return to my kids and I did run again!
I Am Still The Same -Self help stroke recovery tool
Internationally published author ‘Running Free’ (Amazon) . Speaker – Founder Fighting Strokes
Kate’s story in 2 minutes