Having just completed a series of the Aural Apothecary podcast talking to patients, or their advocates, about living with / managing ill health in the UK in 2023 I felt moved to pen an “Aural Apothecary Abstraction “
With the current NHS workforce and workload pressures making access to medical services even more difficult than ever, do we need to help people better navigate which other health professionals they could also see / talk to?
Medical doctors have long occupied a public image of omniscience but as my favourite medical author, Atul Gwande, notes when considering the difficulties that face Medicine in the 21st century “The volume of skills and knowledge has exceeded individual capabilities”.
Doctors’ jobs are almost impossible in modern Medicine, so do we need to break down what they are traditionally highly trained to do, to decide what their unique and specialised skills /knowledge / behaviors are, and which of their many roles could be done, maybe even better, by a different highly trained health professional within the multidisciplinary team?
So, let’s start by breaking down all the roles the public believe doctors are currently being asked to perform, to a more or lesser degree:
Diagnostician
Clinical analyst (Imaging, Pathology)
Interventionalist (Surgeon, Therapist)
Prescriber
Carer (Direct hands on care e.g. within a hospital / care unit )
Educator (about health/ illness)
Researcher
Clinician gatekeeper
And then ask the question : Are all the following types of doctors able to remain highly trained enough to competently perform all of those complex and subtle roles?
Surgeon
Anaesthetist
Psychiatrist
Hospital Specialist e.g., Cardiologist, Endocrinologist, Sexual Health
Hospital Generalist e.g., Paediatrician, Geriatrician, Intensivist
Community expert generalist (General Practitioners)
Radiologist
Pathologist
Academic Medical Doctor
For most doctor groups, I believe the answer is no, with some generalists being notable exceptions.
It accepted that all professionals specialise to some degree and as an example, no self-respecting lawyer would agree to perform a corporate business law role if they were a medial litigation lawyer. So, when it comes to doctors are we inviting public expectation failure?
Now let’s think of other highly clinically trained registered health professional groups who potentially already perform some of these roles. Completely or partially, within their individual scope of professional practice:
Dietitian (Diagnostician, Clinical analyst (Pathology) , Prescriber , Educator)
Nurse (Diagnostician, Clinical analyst (Imaging, Pathology) , Interventionalist (Surgeon, Therapist), Prescriber, Carer ( Direct hands on care) , Educator
Osteopath (Diagnostician, Clinical analyst (Imaging) , Interventionalist (Therapist), Educator
Paramedic (Diagnostician, Clinical analyst (Imaging, Pathology) , Interventionalist (Surgeon, Therapist), Prescriber, Educator)
Pharmacist (Diagnostician, Clinical analyst (Pathology) , Prescriber, Educator
Physiotherapist (Diagnostician, Clinical analyst (Imaging) , Interventionalist (Therapist), Prescriber, Educator
Podiatrist (Diagnostician, Clinical analyst (Imaging, Pathology) , Interventionalist (Surgeon, Therapist), Prescriber, Educator
Before we go any further in my thought experiment, I am making the valid assumption that Doctors, and all the other registered health professionals, have appropriate access to patients’ clinical health records, would know when to refer back to the appropriate clinician expert, and are trained and competent in the following:
Anatomy
Pathology and Physiology
Evidence based care
Person-centred care including Shared Decision Making (SDM) and Compassion
And potentially also competent in:
Microbiology
Pharmacology
Nutrition
Physical manipulation
And so, using some common primary care scenarios that the public should be able to access, let’s go back to my original question- Do I need to see a Doctor – Who else could help me ? ,
Surely the answer is twofold:
1. What do YOU want to see them about? Do you need a diagnostician, a prescriber or an interventionalist or someone that can perform two, or all three , functions ?
Examples might include-
I have new lower back pain.
I am worried about my Asthma treatment.
I am sure my diabetic foot ulcer has become infected.
I think I need a hip replacement.
My mental health has deteriorated, and I have a complex history of schizophrenia. I need help!
I have had terrible diarrhoea for more than 5 days.
I don’t want to take the new tablets the specialist told me to take.
I need help to lose weight.
2. Which health professionals, with which clinical competencies, are available, and have both the capability and capacity to see / talk to YOU, in your preferred location?
See Figure 1 for an illustrative example of a possible Healthcare Professionals’ competency matrix for common primary care scenarios
The public already knows when they need to see a dentist or an optician so shouldn’t we be helping them more to think about the options of seeing other, most appropriate, member(s) of the interconnected health professional team so that all health professionals are fully utilised , and help doctors get on with their specific, but not necessarily unique, role?
It is better to have an open mind than one closed by belief. Anon.
Steve the Chemist
The Aural Apothecary November 2023
Figure 1 : Healthcare Professionals’ competency matrix for common primary care scenarios
Green= Competent to deal with issue
Amber = Might be competent to deal with issue
Red = Not competent to deal with issue
1= Competency expected
2 = Competency dependent on training + scope of practice
3 = Not expected to perform or unnecessary
D= Diagnostician
C= Clinical analyst (Imaging, Pathology)
I = Interventionalist (Surgeon, Therapist)
P= Prescriber
E = Educator (about health/ illness)
