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Medical students and junior doctors can make a difference in the delivery of personalised care


 

Personalised care is a concept that emphasises patients' control in the delivery of their care. In this article, Dr Anna Street shares her thoughts on how the power that medical students and junior doctors have in implementing it is hugely underestimated, and makes a compelling case for personalised care everywhere.

 


I’ve always been a huge advocate for the benefits of personalised care for patients. That’s one of the reasons I specialised in the geriatrics field of medicine rather than other medical specialities, which are perhaps more protocol driven.

For my career development, I undertook the free core quality-assured eLearning courses delivered by the Personalised Care Institute (PCI) to formalise and underpin my knowledge in the principles in delivering personalised care. I found these short 30-60 minute modules extremely helpful in so many ways, including understanding the right vocabulary to use with colleagues, peers and patients about person-centred care in a way that ensures patients are at the centre of their health and care choices. Evidence shows that delivering personalised care has a range of health benefits, such as improved adherence to treatment and quicker recovery times.


The PCI is the national organisation which sets the standards for evidence-based personalised care training. Through my role at HEE East of England, I started to work with the PCI in March 2021 to develop and launch a specific course for junior doctors.


Launched in autumn, the module - Leading Personalised Care as a Junior Doctor - aims to educate Junior Doctors about the principles of personalised care and its relevance to practice.


The PCI’s bespoke course explores why leadership in personalised care is important and is designed to boost the confidence of learners, so they feel equipped to talk to individuals about what’s most important to them. With this knowledge, they can advocate for that person to the rest of the multidisciplinary team. It’s about adjusting and improving what we already do rather than totally changing how we deliver care.


What is personalised care?

Personalised care simply means that patients have more control and choice over the way their care is planned and delivered. It is about considering individual needs, preferences and circumstances, and helping people to choose what is right for them.

Sometimes referred to as patient-centred care or person-centred care, personalised care is a key part of the NHS Long Term Plan. It is a whole system approach that enables a variety of services across the health, social care, public health and community spectrum to be integrated around the individual, so that we can deliver better outcomes and experiences for patients.


Why am I such an advocate of personalised care delivery?

In my own experience, I’ve seen first-hand the results it can achieve when it is incorporated into everyday practice. I believe that in geriatrics medicine in particular, personalised care is extremely important. No two patients are the same: everybody's home life, social situation, previous medical history and medications are unique to that person. It’s a specialism that involves a lot of problem solving. You have to come up with the right solution for that person and sometimes that means not following a protocol.


Medical students and junior doctors can make a massive difference as they really do have it in their power to implement and advocate for personalised care in both primary or secondary settings. When they see a patient and take a full history from them, that’s often the most time any doctor will spend with that person during their hospital stay. Junior doctors and medical students can be instrumental in getting conversations underway which explore what is important for that person.


How has personalised care delivered results in my role?

There have been numerous examples. I had one patient who presented with a severe delirium who wouldn't eat or drink. They lacked capacity to make decisions about feeding themselves. They kept pulling out cannulas for IV fluids and were at risk of becoming dehydrated and malnourished. We were considering a naso-gastric feeding tube. He couldn’t tell us himself what he wanted but his wife felt that based on their previous conversations, he wouldn’t want the tube. His son that told us his father would drink chocolate flavoured fortisip “no matter what is happening in his life”. This exploratory conversation emphasised that the patient’s family were part of his care team and our patient’s oral intake improved dramatically. Just finding some chocolate fortisip wouldn’t have worked for most patients, but it did for him.


More recently, I was sharing a new diagnosis of metastatic lung cancer with a patient. I began a shared decision-making discussion about what her preferences for treatment were. While it was an investment of time to start with, we understood very clearly from her that she didn’t want active treatment. We instead prioritised getting her out of hospital so she could focus her time and energy enjoying her life and interests. We have to keep in mind that sometimes a patient is happy to take a risk that we might not want them to take, but it’s their life and their choice.


Through our education we’re encouraged to do pattern recognition and can often group people into boxes. Inevitably, as clinicians we start thinking about what the diagnosis is from the outset. However, I think that’s dangerous; they have a life outside of that diagnosis and we need to remember that.


Is there further evidence which supports personalised care?

Research by the PCI, based on patient experiences from 4,410 appointments, showed there are many benefits when patients receive personalised care, including:

  • Patients are more likely to understand the advice given and find it easier to follow.

  • Patients are much more likely to feel motivated to follow the advice and to feel in control of their recovery.

  • Patients are much more likely to feel listened to and valued.


However, this isn’t a new concept. William Osler famously once said, “The good physician treats the disease; the great physician treats the patient who has the disease”.


What’s next?

My ambition is that as many junior doctors as possible undertake the training and put principles in place that empower the whole multidisciplinary team to consistently provide it. While many are already implementing it, I’d like personalised care to be more widely recognised and celebrated.


About the Author


Anna Street

ST5 in Geriatric Medicine, East and North Hertfordshire NHS Trust

Leadership Fellow at HEE


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