Talking or Testing? Which is easier?

4 Sep

I recently read a brilliant insight from Dr. Richard Saitz on the INEBRIA Google Group – he was commenting on a discussion about doctors objecting to IBA delivery on the grounds that it is ‘additional work’.  His insight was:

“BUT I have never heard a physician object to doing an electrocardiogram or checking a blood pressure or listening to a heart or ordering a mammogram…So…”additional work” must be code for “additional work for a stigmatized problem” or for something about which people have attitudes about….”

As Richard is a doctor himself, this got me thinking about how we need to get into the psyche of doctors if we want them to implement IBA.  That psyche is undoubtedly formed and normed throughout their lives and especially in education and early years of post-graduate training.

It reflects a wider problem I think which is a reluctance to accept a social model of health where a genuine curiosity about someone’s life and health is helpful in diagnosis and treatment (in the broadest sense).  Why the emphasis on the physical?  My experience is that doctors would love to have a (better) biomedical test for over-consumption of alcohol, even though screening tools are very good, non-invasive etc., because they really don’t want to have to talk to people about it…what does that say?

This reluctance, fear, distaste for actually communicating effectively with patients is very pervasive, and GPs who are very caring, lovely and wise still do not seek out people’s own story, their perspective, their ICE (ideas, concerns and expectations) in consultations as well as they could.  Why?  Well there are many reasons.  But our research in the NHS found that they were not taught it, and even if they were, it was not modelled by others so it wasn’t valued/encouraged.  Our system simply does not prioritise it.  My guess is that the reason underpinning that is probably that we don’t have deep enough pockets to prove it helps, or failing that ‘market it’ anyway (as Pharma do).

So a reluctance to communicate effectively in general makes it hard to feel comfortable with an open conversation about alcohol that IBA really entails.

Your thoughts?

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One Response to “Talking or Testing? Which is easier?”

  1. James Morris October 30, 2013 at 6:54 pm #

    Niamh great post. I keep thinking back to it – that testing is sadly more appealing than talking. I agree totally that in general:

    “doctors would love to have a (better) biomedical test for over-consumption of alcohol, even though screening tools are very good, non-invasive etc.”

    The reasons are complex though. Whilst it may be because “they really don’t want to have to talk to people about it”, we should recognise the general context in which ‘alcohol problems’ are mis-understood, particularly perhaps within medical settings.

    A prevailing mindset that doesn’t see alcohol misuse as a spectrum is possibly more ingrained in medical spheres in some regards. We know psychological not medical approaches are best for supporting what are generally behavioural problems, particularly amongst risky drinkers.

    But GP’s foremost role is to diagnose and treat medical conditions, so it is natural they are inclined to see all problems in this way. Of course they need to recognise risky drinking is an issue that they can help address without medicalising it, and ‘talking not bio-testing’ is the way to do so..

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