Scarlett McNally: Recognising the complexity of healthcare to deliver better health

Being a doctor is a huge privilege. We’re present and trusted at the major points in life: births, deaths, medical interventions and decisions, and navigating long term conditions. Many of these moments seem to happen with little time to plan or discuss. This creates misleading expectations about healthcare, focusing on the scary times and heroic interventions. The media reinforce this simplified vision: healthcare is seen as a one dimensional trip through symptoms, investigations, diagnosis, treatment, and recovery, where the patient is usually a passive recipient of care.

We may pay lip service to shared decision making or the World Health Organization’s definition of health as a state of wellbeing rather than the absence of disease. Many of us know that nutrition, exercise, human connection, and other lifestyle factors massively improve health. But, as soon as we become a patient, our goal is to get treatment rather than achieve overall wellbeing. In my experience as a patient I know that I want the chemotherapy, stem cell transplant, cardiac ablation, hip replacement, or immunotherapy, along with all the tests needed to get each intervention.

Politicians, funders, and organisers of healthcare systems can’t beat this human mindset. We focus on health mostly when we get sick rather than by trying to stay healthy. Record public dissatisfaction with the NHS1 suggests that we need a different approach. To achieve two of the UK government’s planned shifts—from hospital to community and from sickness to prevention—we need three actions. Firstly, we should agree that the healthcare professional making the decision with a patient to do a test or intervention understands all the implications. Secondly, we should be clear what alternatives to interventions are possible and consider the possibility of regret or complications. Thirdly, we should ensure that general measures to improve health are embedded in specific interventional pathways.

All these changes require better teamwork. We need more GPs and geriatricians, but doctors in all settings have the knowledge, skills, and experience to manage complexity with their patients.2 The NHS is a complicated and interconnected system, where all team members make an important contribution to patient care. We particularly need to stop treating surgeons like robots, expected only to operate and complete endless electronic forms in an isolated surgical clinic. Surgery isn’t only about an individual surgeon doing their best: all staff and the patients themselves are included in the pathway.