Demonstrating Changed Hearts
PRIME teaching has been well received all over the world with generally positive feedback. There are many anecdotal examples of how it has influenced not only the practice of medicine but also the heart and direction of those practicing it. Indeed like any learning, it can only be said to be effective once changed attitudes and behaviour have been demonstrated. Perhaps what we have been lacking however is a more structured approach to seeking evidence of this changed behaviour and just as importantly, what is it about the teaching that has enabled the changes to take place.
The team in Uganda has been visiting a Clinical Officer school in Gulu now every year since 2010. During that time we have developed good relationships with staff and observed significant changes in approaches to whole person care and attitudes to patients. Clinical officers are the primary physicians of Sub Saharan Africa and also perform much of the junior doctor roles in hospitals. They only have a three-year course and the curriculum sadly struggles to deliver much in the way of consultation and communication skills, hence our two-day whole person medicine course concentrates on these areas. In October we took the opportunity to revisit the previous year group and gave them questionnaires about the course a year on, asking not only what understanding they had retained, but also the effect it had on their contact with patients. Of the 70 or so we had taught about 45 turned up and responded. I have included below some of the comments, especially those where we asked for examples of individual cases.
Perhaps the most striking point initially is that these were young students in only their second year, yet they are seeing patients with complex and chronic conditions that have a major life impact. We would be hard pressed to find second or third year medical students in the UK undertaking these sorts of consultations.
Furthermore, we have noticed over the years that there is an understandable reluctance; almost fear, in the students to talk about difficult conditions especially when patients are distressed. This is in part related to cultural attitudes to medical powerlessness within the context of a poor prognosis but also to fear of not being able to handle the patient’s reaction. So it is within this context that their stories are so encouraging. Whatever else they are able to advise patients, there is a dawning that “they are the medicine”.
Medical systems all over the world are obsessed with measuring the measurable, often to the exclusion of the more important softer outcomes. Anyone who feels they could contribute to developing this sort of evidence base for PRIME, please feel do contact us.
Dr Rob Sadler, 2016
‘For example; I had a patient who was HIV positive, had extra-T.B with cancer. All the time the patient was crying, so with what I learnt, I gave my time and attention and first trying to be close to him.’
‘Patients appreciated me after counseling since other condition was having the root cause socially and culturally which does not need giving medications (drugs).’
‘Surely the concept of the whole person medicine (body, mind and spirit) has helped me a lot to know the best care for my patients, and how to organize myself before my patients.’
‘What I did made my clients to develop love and trust in me.’
‘I counseled a HIV positive client who went back happy with hope and he gave me a lot of thanks.’
‘In an outreach at Dony; I was approached by a mother with a child that had a sign of moderate malnutrition; this made me think above the clinical view of having the child treated for the malnutrition but also I labored asking the mother about her familial setting and psychological wellbeing of which made me get a lot about the mother and the baby; this led to counseling and advice on top of the medication.’
‘A mother who came to the hospital was newly diagnosed of Hepatitis B and she became so stressed and worried that she would die. However, after the counseling session, she went home much happier and relieved because I could see in her eyes.’
‘Have been able to explore patients life which has enabled me to find out that most of the patients poor prognosis of disease is due to their social life.’
‘Caring for the sick doesn’t mean only the presence of disease. God has changed my attitude.’
‘Six year old male presented to the outpatient department with his care taker, he lost all parents, and I diagnosed him with sickle cell disease. Using whole person medicine I got appropriate information about the boys life and was able to treat and link him to a sickle cell clinic and sponsors for education. Later on he loved and thanked me.’
‘Patients who do not require medicines have been identified and managed very well.’
‘Indeed in this case, It was a patient in psychiatric unit who presented with severe depression and had been on antidepressants for quite a long period of time. But with the knowledge I gained from this course, the patient was able to improve within a short period of time.’
‘A patient came with abdominal pain and constant headache and on requesting or during lab investigations more was suggestive. So when I explored her I came to know that she had unprotected sex and had a fear of having acquired HIV and pregnancy. I explained to her and counseled her and she went back knowing that she was ok, and went back to happy.’
‘I have been able to interact with the patients more freely than before. I have learnt to handle patients as I would like to be handled.’
‘I was able to diagnose a patient who was not willing to talk to most medics due to the good listening skill and feedback.’
‘Well, after counseling the patient on spiritual and psychological basis, the patient became hopeful and adhered to the medications prescribed and became well upon discharge.’
‘I was able to talk to a HIV positive patient who had not known her HIV status till the day I tested her. She was depressed and I talked to her about the life of being HIV positive and how she can still be productive as usual in the community and she was impressed by that.’
‘After giving counseling to the patients psychological issues, he was able to adhere to medications taking and there was an improvement in his condition (drug and substance abuse) and he was totally discharged.’