Dr. George B. Isaac MD - Achieving Patient Involvement in Rheumatology Services

In this brief article by Dr. George B. Isaac MD, we will look at various aspects of the National Health Service together with the impact of patient involvement; we will share the usefulness of an approach we have developed for patient involvement in real-time.

We will also briefly look at some of the challenges facing the NHS in its goal to actively involve patients; we will detail a particular approach and look to see what effect it might have on outcomes; we then propose further research in the area.

Dr. George B. Isaac MD - NHS Activity & Long-term Conditions

The NHS undertakes a tremendous amount of clinical activity, with huge amounts of clinical episodes every day in addition to more than one million scripts being written every day.

It is also worth noting that all interventions in the Western World are of limited benefit. In fact, only 50% of patients with long-term conditions might take their medication. We also know that patient education and their active participation in treatment decisions have an impact on outcomes too. This is in the context of 80% of the NHS spending being on long-term conditions.

NHS Challenges

With budgets reducing at a time of financial crisis it is vitally important that we review how and what we spend, and how effective it is. In addition, we should take every step we can to measure the effectiveness of healthcare interventions but more importantly, look to improve the outcome.

There also remains negative feedback to the service that the NHS might offer, an example being the case of Ian Birrell who summarised his experiences through articles in The Independent newspaper.

We also have to accept that many of the NHS structures are bureaucratic and slow. Decisions involve multiple steps in a complex process and it is not always possible to understand what value is added by these steps in order to discuss and propagate change.

We are going to share with you a simple tool that has been developed over a course of many years to look to get real-time patient feedback and how this has been useful in terms of understanding the patient's point of view but also helping with team and service development.

A Small Solution by Dr. George B. Isaac MD

One small solution to the clinical challenges the NHS faces might be to use real-time patient feedback in addition to patient briefing and debriefing. This tool is based on the Picker Foundation questionnaire and has subsequently been simplified to just two questions; in the current guide, it has several questions, which can be changed over time, but also a free text area to ask for further suggestions.

The principle of getting the patient's feedback or involving patients in a different way is not a new phenomenon. Institutions regularly (as part of the CQC assessment) ask 800 patients for feedback every year. However, all of these measures tend to be some way removed from the actual clinical encounters of given patient and a given clinician on a given day.

Dr. George B. Isaac MD  Experience

There are challenges with the real-time patient feedback, or feedback of any sort, but these are not insurmountable. There are difficulties of where to start and of sustaining the patient involvement over time.

We would like to share some experience we have gained over the last few months.

We noticed that there is a need for training, together with the need to engage and to involve colleagues to demonstrate relevance. There may sometimes be infrastructure problems in addition to other obstacles, but critically there may also be fear.

There is a degree of reluctance and hesitancy in looking to get patient feedback with people being unsure of the objectivity or value of the patient's feedback. There perhaps maybe even negative consequences.

In the past patient, the feedback has been of a limited visibility, but this is all changing with the Department of Health, GMC, patient groups and the patients themselves all agreed on the importance of feedback to the clinical service.

Current Form

The current form of the systematic self-review was formulated with the briefing of the team before the start of the clinic pre and post-consultation questionnaires.

Dr. George B. Isaac MD - Working With Your Doctor for Diagnosing Fibromyalgia

Dr. George B. Isaac MD - For those who are suffering the symptoms, diagnosing fibromyalgia can be very difficult. Fibromyalgia presents as a multi-system, multi-symptom disorder that is frustrating to physicians and leaves sufferers feeling despondent as they search for answers. Many people don't know where to start when they begin to suspect they might have fibromyalgia.

Fibromyalgia often mimics the symptoms of other diseases, often frightening patients who are more familiar with the other diseases. Worrying that something is "really wrong" with them leads people to their doctors and the fear that something more is wrong often presents as "hypochondria." Once the doctor discerns that their patient isn't suffering from cancer or some other terrible disease, they often dismiss their patients thus prolonging the eventual diagnosis of fibromyalgia.

Fibromyalgia presents with a myriad of symptoms that are often confusing and frustrating.

* Pain that is widespread is one of the hallmarks for fibromyalgia. This pain is diffused in all four quadrants, though not always at the same time.

* Pain in the pressure sites when they are touched.

* Chronic Fatigue often plays a part in the diagnosis of fibromyalgia as well. Constant tiredness, feeling of never being rested enough, and irritability due to exhaustion are indicators of Chronic Fatigue.

Dr. George B. Isaac MD - Diagnosing Chronic Fatigue Syndrome (whether with Fibromyalgia or alone) is a daunting task as well. Symptoms include the following;

* Fatigue that is described as new, and unexplained. It persists and has little to do with physical exertion and isn't made any better with bed rest. It also interferes with daily life.
* Headaches that seem to come out of nowhere
* Memory problems and impairment
* Exhaustion
* Sore throat
* Muscle pain
* Joint pain
* Tender or swollen lymph nodes

Symptoms from these lists are usually a good indicator. There are no diagnostic tests that can conclusively diagnose it. While it typically appears in middle-aged adults, it also affects teenagers and even children.

Persistence is the key to getting a diagnosis. Patients should pursue answers to what they believe is wrong with them, and if their doctor isn't willing to listen anymore, they should find another who is. Often fibromyalgia requires a specialist to diagnosis. These specialists are called Rheumatologists and practice Rheumatology.

Rheumatology is known as the practice of medicine that deals with the study and treatment of pathologies of the muscles and tendons. In addition, there is a sub-specialty study of inflammation and autoimmunity. Most Rheumatologists treat disorders like lupus, arthritis, scleroderma, and Lyme disease.

These are the physicians who are better able to make an appropriate diagnosis. Getting to one of these specialists, however, can be very difficult and takes a great deal of persistence. Being patient with your doctor while he excludes other disorders and diseases can be difficult, but if he is willing to work with you while pursuing an answer, he may be worth keeping.

A good doctor will evaluate you on a regular basis, excluding symptoms and afflictions while examining all possibilities for your malaise. Be proactive in seeking a diagnosis while managing and treating the symptoms that are now being revealed. Fibromyalgia is considered to be a disease that has a progressive diagnosis. It takes time, it takes education, and it takes persistence.