Healthcare attitudes ‘harmful’
The health system is not helping, but harming some seriously unwell Kiwis, and needs an attitude overhaul to make it patientfriendly, experts say.
Researcher Dr Helen Francis followed the journey of 16 patients with more than one serious longterm health condition, for five years. She found many were faced with unsurmountable burdens.
She was awarded her doctorate from Massey University’s school of nursing in Manawatu¯ late last year for the study.
‘‘The families I talked to had all sorts of awful things going on in their lives – poverty and other disadvantages.
‘‘The care we offer does not meet their needs as well as it could.’’
Many good doctors and nurses in the primary healthcare system were going above and beyond to help but the programmes available were too rigid and ‘‘tick-box’’, she said.
‘‘There’s a lot of stuff that’s a waste of everybody’s time.
‘‘We’re telling them to go on a course, go for a walk or eat better, or quit smoking, but a lot of the patients I saw were exhausted, it’s one more thing. It’s just not as easy as that.
‘‘It actually makes the patient feel worse, they feel like a failure because they are not achieving the ideal outcomes, and then they have to deal with a health system that berates them.’’
One woman with a heart condition, asthma, diabetes, arthritis and other health conditions was also working as a carer, as well as supporting a seriously unwell daughter, and had become the main caregiver for five grandchildren.
Another who was also very sick was caring for an even more unwell brother who could not be left alone. ‘‘She was supposed to go to the hospital for a respiratory course two times a week but she couldn’t afford the transport, and couldn’t leave her brother.
‘‘The doctor said: well if you don’t care about your health, then that’s up to you.
‘‘People are put down and don’t feel they can stand up for themselves.
‘‘Things are cancelled and they are not told. They’re told: you’ll get your surgery date in the post some- time, so they’ll wait and wait, or they think it must be good news if they haven’t heard back about tests, but they’d been forgotten. Or they finally find they’re waiting because they haven’t sent a sample, when actually they had.’’
Two of her subjects waited 11 months for orthotic shoes. Each pair was unusable when they finally arrived, she said.
Customers would not expect this sort of run around from retailers, and despite the health system being a public service patients should not have to put up with it either, Francis said. She believes better service could be offered with a change of focus and attitudes, that would not necessarily cost the system more.
Palliative care
Another man had not been told his respiratory condition was permanent. He was trying to wean himself off using oxygen tanks because he didn’t want to be dependent on them.
‘‘It’s a regime encouraging him to do better and try harder, and actually he wasn’t going to get much better or to be cured. We should be dealing with that.’’
Francis said it was difficult for patients with multiple serious conditions to make meaningful gains. The best approach was a palliative care approach – to make them comfortable and improve their situation the best that it could be within the barriers they faced.
However, in New Zealand palliative care was typically reserved for people whose conditions are terminal, or who have cancer, she said.
‘‘Palliative really should be for people that aren’t going to get better. To look at what that person’s goals are, and treat them individually and in a more compassionate way.’’
Barriers to healthcare
The Dunedin school of medicine’s Dr Sarah Derrett said she ‘‘wholeheartedly supports’’ Francis’ call for change.
‘‘I do a lot of work looking at patient experiences, and we constantly hear of barriers to accessing health, including significant financial barriers in primary care practices that are prohibitive for many.
‘‘There needs to be a greater focus on placing the patient and their families at the centre rather than the exterior.’’