SAPC Conference - Resilience: A New Metric for Primary Care
I will be pitching patient resilience on the "Dangerous Ideas Soapbox" at this year's SAPC Conference. Each speaker will have 10 minutes to spark the interest and backing of the audience before a final vote to decide the ‘winner’ – who will be invited to publish their idea in the SAPC pages in Primary Health Care Research & Development and on the website. Thought SHE members might be interested - see below for my submission…
"Resilience: a new metric for Primary Care"
"It has often been noted that health is not at the centre of healthcare. Even in primary care most of our work converges on guideline-informed pharmaceutical prescriptions. In 2010, for instance, we issued 37 million of them for antidepressants alone. But what about health? In 1948, WHO entered the frame with its enlightened but flawed definition of health as “a state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity.” This does well to define health in multiple domains and as a positive phenomenon but falls down with the adjective “complete” which, in our co-morbid and aging population, means hardly anyone is healthy, whilst much harm is done in the (fruitless) pursuit of perfection.
"This Dangerous Soapbox idea is to suggest a new metric for health based on the idea of resilience. Resilience describes the properties of a system that can maintain its integrity in the face of external and internal threat. The resilient person has self-knowledge and esteem, knows what do to do stay healthy, what to do to regain equilibrium on falling ill, when to seek help outside itself, and how to adapt to ill health when this is persistent. In particular a resilient system learns from past experience and accepts “pretty good” rather than “complete” health as its norm. How nice it would be to have more resilient patients!
"Key to resilience is strong connections and feedback loops between parts. We often weald pharmaceuticals to mute these loops by, for instance, using a PPI to silence a dyspepsia that is signalling the need for lifestyle change. We foster resilience when we assist people to connect to resources both within themselves, their families and their communities. Systems theory teaches us of the importance of inputs and outputs for systemic health, and nutrition is the most obvious resilience-generating example.
"There is an urgent need to place the promotion of resilience at the centre of our consultation maps such as the Calgary-Cambridge, in preference to the doctor-centred metaphor of “management”. Resilience is promoted through interventions that increase patients’ self-awareness and esteem, improve health-seeking behaviour, foster adaption to symptomatology and encourage nutritional awareness, smoking cessation and exercise (as examples). GPs need to develop their skills in these domains, some of which we reward already. We need smart thinking to find ways to reward others including through QOF.
"The current pharmaceutically-driven culture needs to be modified if we are to restore humanity, contain costs and enhance sustainability. With resilience comes more health but less healthcare, including less screening and less medication, and just maybe, more time to time find out who are patients really are."
Dr Trevor Thompson, Consultant Senior Lecturer, Academic Unit of Primary Health Care, University of Bristol