Dear Editor,
I read with great interest the article by Michelle Mello (2020) regarding practising personalised care for nursing professionals. As a fifth-year medical student at Imperial College London, I can appreciate the importance of this issue to achieve higher patient satisfaction and, therefore, better treatment outcomes.
I think most of my medical student colleagues would agree that we entered the field envisaging a career of helping patients through challenging experiences. However, the reality is that the physical, psychological and social aspects of the work environment lead to high occupational stress levels among health professionals. This leads to high levels of burnout and turnover, which adversely affect patient care.
To resolve occupational stress in the NHS is complex and will require major modifications in staff levels, working hours and salaries. However, a more achievable step to ensure that health professionals do not lose sight of the importance of delivering care empathetically is regular training on how to deliver personalised care. Mello outlines the ‘universal personalised care’ programme that seeks to develop professional skills and behaviours in 75 000 healthcare staff by 2023/2024. A fundamental part of this programme supports the healthcare system's infrastructure to enable staff to sustain the practice of personalised care.
During my undergraduate studies thus far, I have received teaching and assessments on clerking patients, which includes taking a patient's complete history, performing a clinical examination and writing a care plan in the patient notes. As part of the clerking process, much focus is put on the acronym ‘ICE’ that explores the ideas, concerns and expectations of the patient, enabling shared decision-making within the time pressure of a consultation or emergency department interaction.
The curriculum at Imperial College London includes a medical ethics module, which I found incredibly interesting in providing a wider context to the rigorous academia of our study. The module explored the concepts of beneficence and autonomy, which state that humans have the right to their own body and, therefore, can make decisions about their own lives. This suggests that patients should be involved in discussions with the medical and nursing team regarding decisions about treatment plans and procedures, thereby incorporating principles of personalised care. Additionally, we were taught that healthcare practices should always be in the patient's best interests. However, patient values and best interests can differ, highlighting the importance of taking an individualised approach. This is crucial because, when clinicians actively involve a patient in the decision-making process, more favourable outcomes are observed (Smith et al, 2019). This may be due to increased satisfaction, leading to improved compliance with treatment regimens and, consequently, better recovery.
These aspects of medical student teaching imply that medicine, as well as nursing, is moving away from the traditional patient-clinician power balance described by Mello to more open conversations between patients and health professionals to balance the power dynamic. In the long term, personalised care will result in patients being more knowledgeable and better informed, as well as further solidifying the trust between patients and health professionals, leading to higher satisfaction with consultations and more successful outcomes.
Another aspect of patient-centred care emphasised in the article refers to encouraging patients to take responsibility for their health and wellbeing. In my third year at Imperial, I was required to spend a few months at an allocated GP surgery. At the practice, a colleague and I conducted a survey to investigate patient ownership of their health which asked them about their health conditions and regular medications. Of 25 patients surveyed, 52% could not list all the names of their medications and 75% of those with allergies could not name their medications. Consequently, in the event of an emergency, treatment could be delayed or incorrect treatments could be given, leading to potentially severe consequences. This highlights the importance of implementing practices such as shared medical decision-making to improve patient engagement and empower them to manage their conditions.
This is particularly relevant in the current era with unhealthy habits leading to diseases such as obesity. According to the World Health Organization, in 2016, 39% of adults aged 18 years and over were overweight and, overall, 13% of the world's adult population was obese. Between 1975 and 2016, the global prevalence of obesity nearly tripled. The most shocking fact of all is, arguably, that over 240 million young people aged 5-19 years were overweight or obese. Although there are many reasons for the high rates of obesity in young people, a contributing factor is that adults (and parents) are not taking responsibility for their own health. Obesity may be less of a burden if healthcare practices were more individualised to empower individuals to work with health professionals; the increased accountability associated with shared decisions leads to more positive behaviours and lifestyle choices (Smith et al, 2019). As a result, patients will be working with healthcare professionals to optimise their own health and prevent life-threatening diseases.
In conclusion, this thought-provoking article highlighted the importance of supporting health professionals to implement an individualised approach to patient care as outlined in the NHS Long Term Plan (NHS England and NHS Improvement, 2019). I would like to thank Michelle Mello for her informative article on practising personalised care and educating us, as students and health professionals, on how to best treat our patients.