Living with multiple health problems

Satisfaction with care for multiple conditions

People commonly valued doctors who listened to them and explained things sufficiently for them to understand what they needed to know about their conditions or treatments. Amy praised her GP for being a good listener. Tammy found her GP to be honest and straightforward and when she recommended that she take time off work, that advice was just what she needed. Angela also valued being signed off work. Generally, people were very satisfied with GPs who were seen as involved in care in a more holistic (or ‘whole person’) and patient-centred way. The way that medicine is organised according to specialisms relating to types of conditions or those affecting a particular area of the body can create problems for people with multiple health problems. However, specialists are highly valued in relation to individual health conditions and GPs are sometimes criticised for not being specialist enough in individual diseases.
The people we spoke to were satisfied with doctors who were able to pitch medical information at just the right level for them. For example, Mohammed felt his GP gave him just the right level of information about diabetes that he needed. Nigel said his GP knew him very well and was able to get him through a period where he felt suicidal; as well as resolving conflicting advice he had received from specialists and organising smooth referrals for prostate treatments. Jeffrey trusted his GP’s advice and felt that decisions were always made in his best interests. However, Lee’s experience had rather been that specialists “do the telling,” rather than listening. Angela had found mistakes in medical letters which she thought demonstrated that doctors were not listening to her properly.

Health workers’ communication skills vary between sectors, services and individuals. Judgements about whether to put trust in an individual health worker depended on their approachability and whether they are seen to be listening. Fiona was pleased that her GP did not “push” antidepressants on her. Amy contrasted her experience with hospital staff who did not listen to her with the supportive approach of her GP. Tammy and Lottie both said that they had found nurses that they saw regularly to be supportive and they considered all aspects of their care. Ann and Nigel valued regular diabetic checks in order to spot any problems early on.
In short, people valued health workers who listened to them and gave advice which matched their expectations and needs. People were satisfied with GPs who were able to sort things out Seeing the same GP or specialist was also highly valued as was support provided following hospital discharge (also see ‘Continuity of care’).

As noted in the topic ‘Prioritising multiple health problems,’ doctors and patients might not agree on which conditions are the most in need of attention. Whilst GPs were valued for being able to take a ‘whole person view,’ Anne Y felt that her GP could not help her to come to terms with her epilepsy diagnosis as they are not a specialist in that condition. Eric felt that health services only deal with one problem at a time, which is clearly an issue for people with multiple health problems. Val felt that care is not holistic enough and that conditions seem to be treated in isolation and without regard to her other health problems. Tammy would have preferred one doctor to take charge of everything and her experience was that her care had been more holistic when she was a child. Others were embarrassed about using health care too much and recognised that their GPs seemed to be overworked. Ronald kept raising an issue that was bothering him but received no response.
Health problems affect people in different ways (see ‘The personal impact of multiple health problems’). The complexity brought by different combinations of health problems and drugs creates problems for patients and doctors alike. Andrew spoke about how health care needs to account for lots of different factors in order to be successful. Some people referred back to their GP when faced with conflicting advice. For example, Lottie said that only her GP had an overview of all of her problems. However, Anne X said that whilst doctors do their best, it is impossible for them to know about all medical conditions.
Given the apparent need for a tailor made approach to the clinical management of people with multiple health conditions (see our Resources section) people’s individual wider life circumstances are important. Barry became aggressive and depressed after having a stroke but found that there had been no support for his psychological problems. Similarly, Derrick had found it difficult to control his emotions after a stroke, but there didn’t seem to be any support from the health service around that. Pat and Fiona said they wanted more psychological support in relation to their health problems. Such issues appeared magnified when people lived alone (see also ‘Peer support’). On the whole, these accounts highlighted that there sometimes seemed to be a lack of perceived fit between what people felt they needed help with and the support they received.
As well as feeling a need for more emotional and psychological help, some people said they would like help with more practical issues such as cleaning or domestic chores. For people with or without a diagnosis of a mental health problem, psychological support seemed to usually involve a long wait for help. When they couldn’t get such support from services some people looked for peer support, whether in face-to-face groups or online forums (see also ‘Self-management of medicines). People found things such as seminars and information sessions (e.g. on diet, lung problems) to be valuable; as were those instances where the NHS had contributed to the costs of, for example, gym membership or slimming classes.

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