Our healthcare systems are currently going through vast changes. Possibly some of the most significant transformations since Enlightenment. The medical establishment, the technology industry and patients are integrating in a manner which has not been witnessed before. The technological changes in patient online access to Electronic Patient Health Records (EPHRs) is potentially more convenient for patients, empowers and enables them to take better control of their health and health behaviour, helps them to navigate a complex system, and may make services more efficient and cost-effective. But there is also the possibility for unintended harm, particularly related to privacy and confidentiality, and patients with complex needs or potential vulnerabilities could potentially experience significant impacts to their healthcare and relationship with their providers. Continue reading “Could we be experiencing one of the most significant healthcare transformations since Enlightenment and what are the implications for patients?”
‘Giving up smoking is easy. I’ve done it 100s of times’ Mark Twain
Most people who have given up smoking will probably be familiar with this well-known quote. We all will have made behaviour changes. Some are so effortless we may not even be aware we have made them. Others can fill us with dread. New Year’s resolutions we know will probably be ‘thrown out of the window’ by February.
People who work with behaviour change often use models to help them work in a more appropriate and time efficient manner. One of the most commonly known behaviour change models is the ‘stages of change’ by Prochaska and DiClemente. Within this model people usually transition through six stages (pre-contemplation, contemplation, preparation, action, possible relapse/ lapse) before they finally reach a more stable setting known as ‘maintenance’. This transition can happen at different rates and depend on many various external and internal factors. Continue reading “The different dimensions of working with behaviour change. Exploring internal and external influences”
The current view of domestic abuse and homicide rates
Domestic abuse is a gendered crime. The statistics speak for themselves. Approximately 112 women are killed every year in domestic abuse compared to 12 men. As it is a gendered crime, it makes logical sense to align this to feminist theory, and that if we could diminish our paternalistic society, increase equality between men and women, then domestic abuse would decrease and homicide would fall. This is a great theory. The problem is it doesn’t seem to have completely worked. Not in terms of prevalence anyway. Continue reading “Re-framing abuse: Can we see the wood for the trees?”
We shop, bank, socialise and work via the internet. Online healthcare seems a natural progression in our heavily technology dominated lifestyles. There could be many benefits to being able to engage with our healthcare via the internet and it may help to create more flexibility and convenience in our increasingly hectic schedules.
But some people have genuine concerns about this sort of technology being implemented. Perhaps we should all have some concerns, as there may be points in our lives when circumstances change, we become older, and the implications for online healthcare could become greater. Continue reading “Online access to medical records: Patients and clinicians voice some of their concerns.”
I have a friend, Matt. He is a lean and muscular build and has a BMI of 20.57, which puts him in the healthy weight box. He is 49 years old and very active. He walks, cycles and I have completed a seven-day mountain GR5 mountain hike with him. He also has a PhD in Nutrition. Not really the sort of person you would expect to be at risk of type 2 diabetes, but in 2016 Matt had an hba1c blood sugar reading of 43. This puts him in the ‘pre-diabetic’ and ‘at risk’ category. Continue reading “Diabetes. Who is really at risk?”
When training clinicians about IRIS (the General Practice domestic abuse service) they would sometimes tell me that they had made many referrals into the IRIS service that year. Occasionally this would happen at a practice from which I had received no referrals at all.
Intrigued by this discrepancy I would ask more questions. It transpired that the clinicians thought that they were referring into the service (IRIS) but in fact, what they were actually doing was signposting to the service. This ‘difference’ made all the difference, and the intended recipient was usually lost in the process. Continue reading “Engaging potentially vulnerable client groups. Referrals and signposting. What’s the difference?”
Many of us are already using online healthcare facilities. ‘Patient Access’ has been available for some time. I use it myself for convenient repeat prescriptions. The area of digital health technology is growing at a phenomenal rate as it is being incorporated into apps and internet access. Government policy intends that ‘electronic personal health records’ will eventually be accessible to every adult in the UK via the internet and are supporting an NHS app to help create this future vision. This means that patient investigation results, prescriptions, health files and appointment booking facilities will be available for the general population to access from their personal computers and smartphones. Continue reading “ELECTRONIC PERSONAL HEALTH RECORDS. There are many benefits but what about the risks?”
The SafeLives Dash is the most commonly used risk assessment tool available to help professionals assess the risk of serious harm and homicide for domestic abuse victims. It has been absolutely invaluable in my work.
When risk assessing women who experienced domestic abuse, I have always asked the question ‘Are you very frightened?’ It is question number two on the DASH. Fairly frequently, they would respond to the question by saying ‘No, I’m not feeling frightened.’
I would continue the assessment. ‘Have you ever been raped?…. Have you ever been strangled?’ They would sometimes reply ‘Yes’ despite having just told me that they were not feeling afraid.
Continue reading “Are you afraid? Identifying victims of domestic abuse. Ask the question but don’t always expect a straightforward answer”
Domestic abuse is more common than you may think. Approximately 27% of women, 15% of men and 24% of children will experience an abusive relationship at some point in their lives. People who are experiencing domestic abuse will have more contact with health services than an average patient. A study conducted in Hackney showed that approximately 17% of women in a general practice waiting room may have experienced physical violence within the last year. With high rates of prevalence, it is essential that health services are well equipped to understand and respond to domestic abuse appropriately.