“Medicine's ground state is uncertainty. And wisdom - for both patients and doctors - is defined by how one copes with it.” 1I think the health discourse has begun to move. Move from the acceptance or expectation that a healthcare professional does something to the patient or for the patient. To one where both the patient and healthcare professional co-produce health in partnership. In other words a move where medicine is done ‘to’ an individual, to a working ‘with’ relationship.
When we talk about co-production it can, at first, seem a complicated idea. In essence it means to make together. It extends upon the idea of professionals working together across work or organisational boundaries, a model I became familiar with in my social care career. It brings into the conversation, in a meaningful way, the individual, group, or community as equal partners in the planning, implementation and evaluation of their health and well-being.
For this to happen will require an examination of our roles as patients and professionals in relation to health, education, culture and politics. It embraces an idea of a more active form of citizenship. It will require us to acknowledge and act together upon the affects of impoverishment on peoples health and well-being as a consequence of economic, social and cultural inequality.
It can seem the most difficult conversation to begin. From a professional point of view the active engagement of patients and carers in the co-production of health would seem the least effective or even wished for way to work. It will require healthcare professionals to examine some of the values and assumptions that underpin their practice. It will prove a challenge, given the inherent status, power and control that comes with the role.
I hear the same repeated themes in my conversations with patients and carers about what they want from healthcare professionals. They want to feel included as far as possible in the important decisions about their healthcare choices. They want to feel the benefits of a team of professionals who work with the patient in the patient's best interest.
As I did when I worked in my various roles for social care and continue to do so now in my work with students and healthcare professionals. One must engage in a ongoing dialogue to answer some simple questions: ‘Who do you work for?’ and ‘Who's needs do I / we meet when I / we make an important decision about an individual's or a communities health needs?’
No one said that the work of healthcare in the 21st century will be easy. It will require healthcare professionals to explore the difficult discourse of uncertainty with patients, carers and fellow professionals. It will require the learning and practice of complementary skills with the same dedication given to the clinical skills learnt as part of medical training. Skills such as facilitation, care-coordination, care-planning, and advocacy, among others.
When I worked with the Darzi fellows in 2014 as part of the PCC from Leeds talking about coproduction I left the events buoyed by the passion and energy I witnessed. I felt hopeful that the health professionals and leaders of tomorrow will continue to work, advocate and value the knowledge, skills and experience that patients and carers bring. Not just to manage their own health needs but for the co-design and development of our health services.
1. Atul Gawande. Complications: A Surgeon's Notes on an Imperfect Science. 2nd ed. London: Profile Books; 2008.