Sunday, 22 January 2017

Unrelenting Kindness meets Unconditional Positive Regard - Being There for Others

It appears difficult to find data on how many people change their GP each year. The best I could do this morning was a study published in 1997 which shows up to 4% changed their GP for reasons other than moving house, and a more recent study in 2012 which showed a lower figure of 1.9%. If one forgets percentages and thinks about actual figures, this could mean up to 1.3m people in the UK might change their doctor each year. The top 3 reasons given in both studies for moving to a new GP were: (1) accessibility (including distance) (2) attitude of doctor (rudeness, not listening) and (3) clinical management (the difference between what the person wanted and what their GP gave them, most often around the prescribing of medication).

I mention these facts for 2 reasons. One of my daughters recently changed GPs. In the UK it’s easy to do, and you don’t even have to let your GP know you are doing it. She changed her GP practice due to a conflict over getting a flu vaccination for one of her young children. The child’s school had said it should be done by a GP, the GP said they wouldn’t do it as it was available to children at school. Now my daughter is aged 34 and from a generation that appears to know best, knows what they want, and have no problem expressing their expectations in person, on-line, by phone, and often do so with utter conviction they are right. I know as I’m her Dad.

Her sons eventually got their flu vaccination – from a practice nurse at the new GP practice, and all is well. Her story is perhaps symptomatic of what might be contributing to some of the current problems with the UK health care service. Many people have high expectations of what they are entitled to, including the right to the best possible health care right now, right here. Maybe it's simply a form of cognitive dissonance that results in so many people turning up at A+E departments when they are clearly not requiring emergency care. Maybe it’s some mass renaissance evocation of the Talcott Parson sick role theory where notions of personal rights trump any sense of personal responsibility for one’s health and well-being.

As I said in last week’s blog (see here) there is a great deal more we could do, need to do, in using education aimed at helping more people take sensible and informed decisions over managing their own health care – and it is the generation coming through in our schools today that perhaps deserve the most focus. Of course, there will always be people that will need access to effective, evidence based health care, and in the UK we provide this extremely well.

For many years I have been trying to promote a greater understanding of what the practice of health care means in relation to the science of health care. The second reason for my noting the GP data above comes from a fantastic example of what I mean by the practice/science dichotomy. Last week, after I published my blog I received a Twitter DM. It was a message that came from a man I have never met. He told me of how his thinking had changed after reading a blog I had posted way back in 2010, which included a comment on a wonderfully courageous young lady I had met who described her experience of receiving mental health care over an 8 year period.

When I met her she was 19 years old and talked of the care she had received from her GP, which she described as being un-remitting, constant and reliable. Hearing her account made me think more about the notion of unconditional positive regard (UPR) for others, and this is what I was commenting upon. UPR is a concept I have tried to employ over many years in my clinical practice, as a manager, leader and educator. It was this young ladies GP who contacted me and he told me at the time he was reading my blog, he wasn’t familiar with the UPR.

Of all the skills a health care professional has to acquire UPR is by far the most complex and difficult to learn. Being able to accept other's unconditionally helps ensure that the health care professional is able to provide non-judgmental support and care. For me UPR is an essential requirement in truly providing person-centred care. It is not an easy approach. In mental health care, being there for others whatever they say, or do is crucial in establishing and maintaining a therapeutic relationship. I believe UPR helps practitioners to stay there, and be there for others.

The GP who contacted me works for one of the most exciting organisations providing health care in Manchester. Here is a quote from their website – The greatest disease in the West today is not TB or Leprosy; it is being unwanted, unloved and uncared for. We can cure physical disease with medicine, but the only cure for loneliness, despair and hopelessness is love -  They have further developed the notion of UPR in their work and now promote and live the notion of ‘relentless kindness’. Just have a look at their website and be truly inspired! 

When I was trying find data on how often we might choose to change our GP one of the sites I came across was one quoting the Competition and Markets Authority data on banks. They reported that although about 10% of us might change our bank, over 57% of us have been with the same bank for over 10 years, and about 40% of us have had the same bank account for over 20 years. Indeed on average we are more likely to stay with our bank (typically for 17 years) than remain married – the average marriage in the UK lasts 11 years and 6 months. It would appear that in many areas of our lives, love and kindness are attributes not to be ignored, but nourished.