Sam Finnikin: Rethinking medicine one step at a time

I was fortunate to attend the Rethinking Medicine conference held in London on the 11th March 2020 and it has got me thinking about re-thinking medicine. This event was born from a collaboration between NHS England and the Royal College of General Practitioners who have been working on “Rethinking Medicine” over the last couple of years. With artful facilitation by the team from Kaleidoscope Health and Care, this was an opportunity to explore how healthcare in England can be better for patients and clinicians. So what is it all about, and how is it going to achieve its ambitious aims?

Firstly, there is a fundamental premise that healthcare at the moment is floundering. No one is doubting that advances in healthcare have benefited humankind over recent decades; but there is a feeling amongst many that healthcare is overstretching itself. That we, as a society, have been seduced by the benefits we have seen and have become over reliant on medicine to solve our problems. This has resulted in the unrelenting transformation of people into patients and these patients being subject to increasing amounts of healthcare, often with diminishing benefit and, in some cases, even harm. More and more resources are ploughed into low value activities and healthcare has become a distraction from the wider determinants of health. The feeling that we could be doing better has given rise to a number of initiatives across the world trying to redress the balance in healthcare; and Rethinking Medicine is one of them.

The “why” is clear, but the “how” is less tangible and more difficult to grasp. It’s perhaps best thought of as a philosophy for how we could be improving healthcare. A philosophy that aims to inspire clinicians and patients to it’s cause to engender change in a ground-up fashion. It was fitting, therefore, that Victor Montori was invited to address the group as he has spearheaded a “patient revolution” with his thought provoking book “Why We Revolt.” Victor is an endocrinologist in the US and has a deep understanding of the problems of modern healthcare. He passionately calls for change and proposes solutions based on rejecting industrialised healthcare and instead focusing on the patient and making “care” the centre of everything we do. Caring for the individual patient through unhurried conversations which foster bilateral understanding; the clinician gaining an understanding of what’s important to the patient, and the patient gaining an understanding of how medicine may, or may not, help them flourish. The importance of partnership was a recurrent theme throughout the event and must be central to the future of healthcare.

Of course, this approach to healthcare could be criticised as being fanciful and unrealistic. But although the room was full of enthusiasts for this approach, many were front line clinicians who are not blind to the challenges we face in order to  realise this ideal. One of the founders of Rethinking Medicine, Martin Marshall (Chair of the RCGP) is well aware of the difficulties facing clinicians and patients who are trying to change the way we do healthcare. But he reminded us to start with where we’re at now. If we make incremental changes in the right direction, then eventually we will look back and see how far we have come. We may not lack the time to share decisions, the right information to inform choice, or the skills to communicate risk. But over time this can change, and we can start by making small changes and build from there. Mohanpal Singh, a GP in the West Midlands who has bought a new approach to healthcare to his patients, painted a picture of healthcare that was made up of multiple small conversations. Just one truly patient centred conversation may be enough to start that patient on a different healthcare path. One with fewer medicines, interventions and consultations but better health. Multiple conversations over time can start to have a lasting positive impact.

But this isn’t just the right thing for patients; it is also the right thing for clinicians. Clinicians are burning out in the current healthcare system. The pressures of increasing workload, increasing complexity and fear of litigation are pushing many to the edge. We need to rethink medicine for the sake of clinicians as well as patients. This philosophy gives clinicians permission to turn away from their computers and engage with their patients on a personal level, or to open themselves up to, and partner with their patients. It gives them permission to stop hiding behind protocols and guidelines and rediscover the joy in medicine through meaningful collaborative conversations. Yes this is scary and difficult; but many are feeling like they can’t continue on their current path, so it’s worth a try.

I know it is much more difficult in practice than it may seem sitting in a room of enthusiasts getting carried away with the possibility of a different way of doing things. I know it will take time and persistence before things change. And I’m aware that it’s not just clinicians who will need to change the way we think, but patients will need to be involved every step of the way and leading the imperative for change. Victor suggested it may take a lifetime to realise the benefits of the revolution he has started. But however long it takes, if we just keep making small changes that move us in the right direction, then Rethinking Medicine can achieve its aims and healthcare can work better for everyone.

Sam Finnikin is a GP in Sutton Coldfield and a clinical research fellow at the University of Birmingham. He is interested in how we can improve shared decision making every day practice. Twitter: @sfinnikin

Competing interests: SF was previously affiliated with NICE in a non paid role as a NICE scholar 2015-2016 . He is currently employed by the RCGP as a Fellow for Evidence and Values and also receives income for freelance lecturing and writing