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The big picture
Author(s) -
Simmons John
Publication year - 2018
Publication title -
veterinary record
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.261
H-Index - 99
eISSN - 2042-7670
pISSN - 0042-4900
DOI - 10.1136/vr.k600
Subject(s) - citation , computer science , library science
If I could wave a magic wand and endow all doctors with one attribute, I would choose the ability to see the big picture in everything we do. By this I mean the capacity to ask the crucial questions in every encounter. What does this patient really want from me? Who else is close to the patient and what do they want?What is my own role as a doctor in this case? How does it fit in with the roles of all the other doctors, and all the other professionals? Are we all just doing little unconnected bits of things to the patient, or are we working together to provide the single thing this patient most wants or needs? I could give innumerable examples from everyday practice of where these questions haven’t been asked, and so the big picture has been lost, or was never even noticed in the first place. Here is a typical one. A 60-year-old man with lots of past heart surgery comes into outpatients wanting a simple answer to a simple question: ‘Is there any significant chance that further tests or operations will help me, or should I just put up with my current level of angina?’ Instead of a straightforward answer, or even a frank admission of uncertainty, he gets sucked back immediately into the machinedboth literally and metaphorically. He has more tests, and yet more tests, and ends up with further surgery based on what the angiogram looks like rather than a serious and prolonged conversation with him. Another example: an 80-year-old woman is whisked into hospital with a broken hip and taken straight into the operating theatre where her hip is expertly repaired. However, no-one has been able to take a proper medication history because she is confused, and no-one has bothered to phone her children or the general practitioner to ask which pills she is taking. Because of this, she goes into heart failure after the operation. These cases are based on real examples. Ask your non-medical friends or members of your family, and you will hear dozens more stories like this. Sadly, you will probably hear even worse ones as well. Yet the remedies for these kinds of problems are not complex, nor are they expensive. They depend on something called systemic awareness, or systemic literacy.