Thursday, 30 July 2015

Continuity of care. . .

I always thought that it would be either my depression or OCD that would eventually end my life especially when they were at their worst a few years ago. But recently I’ve come to realise that it’s actually my physical health that will cause my demise.

I’ve worked hard against extreme odds to deal with my OCD. It’s been a real struggle and hasn’t been easy as my epilepsy complicates the issue as does the state of my housing and the decline of my physical health.

Having said that the problems with my housing should never have occurred and had the housing association kept up with the maintenance, repairs and provided the appropriate adaptations wouldn’t have occurred. With regards to my physical health there is no need for it to have deteriorated had I been provided with the appropriate treatment as and when it was required. But the stumbling block has been a lack of continuity and communication between the various teams that I have to see and some of the staff not being able to see past my mental health problems.

All too often they make unfair assumptions about me frequently based on their previous experiences of other patients with OCD. We don’t all have health anxiety or fail to comply with recommended treatment.

For long term conditions especially those with multiple long term conditions, continuity of care is essential but sadly many still don’t experience this.

What constitutes good continuity of care?

  • Always seeing the same health care professional
  • Where seeing the same person isn’t always possible keeping the numbers seen to a minimum
  • Being introduced to the other members of the team so we are familiar with them.
  • Being included 
But for this to work then notes need to be clear and concise indicating treatment plan and why being followed.

Recently I've fallen foul of a system that isn’t always geared up to provide continuity of care.

I’d seen one of my consultants who’d told me my blood results were normal. I’d been given a copy of them and when I got home I’d checked them. They were far from normal. I couldn’t get hold of the consultant and so turned up at the clinic the following week to see someone. The consultant wasn’t there so I had to see another member of the team. They went on to give me a long lecture on primary hypothyroidism (I have secondary). He also thought the considerable drop in thyroid levels was caused by malabsorption which I agree. I was told to up the dose and have repeat blood tests in 4-6 weeks which I did. When I tried to get the results I had to speak to yet another member of the team who informed me that despite my levels still being low I was over medicated which I’m not.

I’m telling you this because much of this could have been avoided if I’d had a proper treatment plan and in my notes a page stating clearly: 
  • My medical conditions
  • Treatments for each condition
  • Reasons for each treatment. 
  • Previous treatments & why they were stopped.
Without this it makes it difficult for other members of the team to provide consistent care especially if you have an atypical diagnosis or diagnoses and have over the years accumulated a stack of notes.

Holistic inclusive care

But continuity of care isn’t just about seeing the same person; it’s about the team/s seeing the whole person and treating them accordingly. It’s about listening to the patient in order to understand them not simply to reply to them, it’s about working with the patient to provide care and treatment and that includes asking the patient if there are any factors that make their condition better or worse.

There is no point focusing on and treating one condition without considering and treating the other factors that either caused or are contributing to the problem. We are complex organisms and as such you can’t treat one condition in isolation without considering how it or the treatment provided impacts on the rest of the body.

Unfortunately the NHS is over the years become more and more focused on providing specialist treatment and in many cases the system simply isn’t 
equipped to deal with those of us with multiple long term conditions. If we have symptoms that cross more than one specialty we frequently end up in a situation where each team either assumes or hopes that one of the other teams will deal with the symptoms and so we often end up feeling like a parcel being passed from one team to another with the symptoms remaining untreated and our condition deteriorating as a result.

For good continuity of care we need one of our consultants to take the lead and coordinate our care ensuring that all teams communicate with and work with each other so providing us with good quality holistic care. Okay initially this is time consuming but pays dividends as results in less complications and our health less likely to deteriorate unnecessarily.

Follow me on Twitter

1 comment:

  1. thank you I have the same problem to mainly though with one consultant the others have CC everyone into my notes I agree that you should have one lead consultant to help work with the other doctors on my various diagnosis I have mental health and physical health to I agree I very much into person centred care but also looking at person holistically but also respectfully caring being kind showing compassion and having empathy for another human being. I like it when we work as a team doctors nurses listen and we work together to help me live with my chronic condition I am all for a care plan but also living in a house that will help you because of these difficulties would be helpful with the physical and mental it will make you feel so much better instead of making things worse your physical surroundings can help with your physical problems as well as mental and lift up your mood.


Thank you for taking the time to comment on my blog.
Your comment is much appreciated