It seems that institutionalised paternalism is alive and kicking in the NHS.
The principle of long-term condition care is that patients become responsible for their own health.
Improved technology has meant that home monitoring becomes increasingly possible. However rather than encourage this we seem to have an institutional need to maintain dependence. For instance, there is evidence that patient monitoring and dosing of warfarin is probably safer and probably provides no worse international normalized ratio control than dragging patients back to clinic.1 NICE however does not recommend this.2
Blood pressure monitors are becoming cheaper. We are encouraged to use them as a means of diagnosing hypertension. Although the Quality and Outcomes Framework documents do not expressly state that the practice is responsible for checking patient blood pressures, the implication is that the patient will be seen every 6 months and a blood pressure recorded. Is this necessary? If we treat patients as responsible adults, surely there is no reason why a patient should not be advised to monitor their blood pressure every 3–6 months, and contact the practice if the blood pressure falls out of defined ranges. Does the practice need to record the blood pressure? Does the patient need to attend the surgery if all is well controlled? If so, how often? Every 3–5 years?
In an NHS where resources are increasingly scarce, the importance of people taking responsibility for their own health seems a priority. I wonder if, as health professionals, we are ready for this.
REFERENCES
- 1.Heneghan C, Ward A, Perera R, et al. Self-monitoring of oral anticoagulation: systematic review and meta-analysis of individual patient data. Lancet. 2012;379(9813):322–334. doi: 10.1016/S0140-6736(11)61294-4. [DOI] [PubMed] [Google Scholar]
- 2.National Institute for Health and Clinical Excellence . Venous thromboembolic diseases. London: NICE; 2012. Clinical guidance 144. [Google Scholar]