Promising breakthrough: dramatic miracle cure offers hope to victims

The problem with headlines about medical breakthroughs and miracle cures is that they never live up to the expectations. On the other hand, the breakthroughs happening every day in primary care do not attract much media attention.

Seventeen years ago medical journalist professor Schwitzer published the seven words you shouldn’t use in medical news: ‘promise’, ‘breakthrough’, ‘dramatic’, ‘miracle’, ‘cure’, ‘hope’ and ‘victim’. Has Schwitzer’s taboo list made an impact?

Words you shouldn't use in medical news
Source: Twitter

Not really. A quick Google search shows that the same words are still used to celebrate ‘heroic medicine’ – often surgical interventions, new drugs or medical technologies. Scientific progress and developments are important but not always easily translated to every day care for every day Australians. They are never ‘miracle cures’.

At the same time we are seeing an increase in spending on hospital treatments but little investment in keeping Australians healthy and out of hospital. Although the breakthroughs in primary care are not regarded as newsworthy, they are often life-changing.

Dramatic & miraculous examples

Here are some of the amazing health ‘breakthroughs’ that are happening every day in Australian communities:

The patient who, supported by her general practice team, feels so much better after getting control of her diabetes. The person with a mental health condition who, after many months of hard work, and treatment by his psychologist and GP, is able to do the groceries again without a panic attack.

The woman who died peacefully at home, according to her wishes with close family around and supported by her GP and the palliative care team. The obese man who has been able to lose weight as a result of determination and regular contact with his GP and allied health team.

The patients who were glad they came in for a blood pressure check or immunisation because the general practice team picked up a heart murmur or melanoma. The highly anxious child who returned to school with help from the multidisciplinary team – much to the relief of the parents.

Medical news: wrong headlines
News headlines: room for improvement?

 

The courageous person who opened up and told his GP or practice nurse what he has never shared with anyone else before – and made a start to change his life. The worried parents demanding antibiotics for their feverish baby, but eventually leaving the GP practice relieved and without a script because they know the infection is self-limiting.

The hospital admissions avoided through a phone call by the GP – with a concerned patient, allied health professional, aged care facility nurse or hospital doctor. The elderly, isolated and malnourished patient who improved and continued to live independently with support from community nurses and the general practice team.

The consultation around the plastic bag of medication boxes brought in by a patient after a visit to the hospital – an essential chat about which tablets to take and when, to make sure she gets better.

Promising breakthroughs

Professor Lesley Russell Wolpe wrote in Inside Story about the value of incremental care. She said: “Heroic medicine has its place, but treating it as the core of medicine means that the majority of government funding goes to hospitals, acute care and elective surgery, a situation that is reinforced by the political imperative to deliver visible returns in a short election cycle.”

She said: “Treating general practice as a speciality in its own right — along the lines of the current advertising campaign ‘I’m not just a GP. I’m your specialist in life’ run by the Royal Australian College of General Practitioners — would help. Ensuring that primary care has the resources to keep up with its central role in the healthcare system is also vital.”

In the years ahead more ‘dramatic breakthroughs’ will continue to come from primary care teams who, day in and day out, assist people with important health decisions and adjustments in their lives. It is time to change the headlines. It is time for decision-makers to increase their support for primary care.

As RACGP president Dr Bastian Seidel said in The Australian: “Our patients want health, they don’t necessarily want treatment”.

Social determinants of health: Why I am all tip and no iceberg

Why I am all tip and no iceberg

In the ‘Blogging on Demand’ series you get to choose the topic. If you have a great idea you want the world to know about, send an email, contact me via social media or leave a comment below. Melissa Sweet suggested the topic of this post: ‘Social determinants of health’. She tweeted: “Interested in your take on SDOH & how they play out locally.” Thankfully, to make the task easier, Melissa suggested some background reading: 436 articles from the Croakey archives.

Note: ‘Social determinants of health’ are economic and social conditions that influence the health of people and communities.

 

“Doc, that’s not going to work.” The health worker was standing behind me. She had overheard my consultation with the elderly man. I thought I was doing a great job, as I had taken the time to explain what diabetes was all about – in layman’s terms – and how he should inject the insulin.

The indigenous health worker continued: “He lives mostly outside and keeps his medications under a tree.” I couldn’t believe what she had just said. When the penny dropped I realised she was, of course, right: the insulin wouldn’t last in the excessive heat of the Kimberley.

It was clear that I had no idea of my patients’ living circumstances. I felt like a fool.

The home visit

Another time, another place. I was doing a home visit in a Cape York indigenous community as part of a team consisting of two nurses, a social worker, a health worker, a police officer and a local government representative.

The verandah was covered with rubbish and furniture. It was hot inside. The room was empty, apart from a few mattresses. The concrete floor and walls were dirty. “How many people live here?” I asked. “Between 8-20, depending on when you visit,” said the social worker.

The patient was lying on a mattress – she clearly only had a short time to live. There was not much I could do apart from some small medication changes. Afterwards, we had a long chat on the verandah about fixing the air-conditioning and the tap, and making her last days as comfortable as possible.

All tip and no iceberg

The contribution of doctors and other health care professionals to our wellbeing is relatively small: Depending on what source you read, healthcare contributes for about 25 percent to our health. On the other hand, an estimated 50 percent of our health is determined by economic and social conditions (see image).

One of Australia’s leading researchers on the economic and social determinants of health is Professor of Public Health Fran Baum. “Typically,” she writes in this editorial, “responses to diseases and health problems are knee jerk and concerned with ameliorating immediate and visible concerns.”

Professor Baum calls this the ‘all tip and no iceberg’ approach. Instead of focussing on disease and unhealthy behaviours we should improve the conditions of everyday life.

To combat the chronic disease and obesity epidemic for example, we should not just be advising lifestyle changes and initiating medical treatment. These are tip-of-the-iceberg solutions.

Instead, says Baum, let’s look below the surface at things like urban planning, the availability of unhealthy food, our sedentary lifestyles at home and at work, and equal opportunities for all.

Social determinants of health
Image: About 50% of our health is determined by economic and social conditions (green). Source: Adapted from a presentation by Professor Fran Baum

General practice

In my work the influence of economic and social factors is apparent. Some examples:

  • The 26-year old single mother who cannot afford medications for her children
  • The 38-year old machine operator who gained 10 kg of weight since he started a fly-in-fly-out job in a remote mining community
  • The 50-year old chief executive who makes 14-hour days in a high-pressure environment, and develops anxiety symptoms.

My role as a GP in these scenarios is modest. Ok, ‘all tip and no iceberg’ may be too harsh – apart from the fact that it sounds like ‘all icing and no cake’…

But Professor Baum has an important message: We must not close our eyes to what really makes us ill and, more importantly, change it.

Thanks to Melissa Sweet for the topic suggestion.

Follow me on Twitter: @EdwinKruys

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