According to Michael Wilks, Chairman of the Standing Committee of European Doctors (CPME; an organisation facing the challenges of its current 2 million doctors in 27 countries being expanded by an ever-growing EU), these are two major influences of healthcare provision. The CPME has subcommittees that deal with four areas concerning doctors at an EU level:
- the organisation of healthcare
- prevention of disease
- ethics of medicine
These subcommittees report to the Board, and the CPME also comprises a Secretariat, Executive Committee and General Assembly. The mandate of the CPME is simple; to improve the healthcare for patients, and Wilks is of the opinion that this can only be achieved by increasing the interaction with patients. In his talk at the World Healthcare Congress, Wilks discussed four issues that will influence the relationship between patients and their doctors – and therefore the quality of the healthcare they receive.
Wilks posed the question: do healthcare policies really work? He presented evidence to indicate that no, they don’t – or at least, not in isolation. Evidence suggests that the only thing really influencing healthcare was wealth.
The old style of healthcare with a single doctor-patient relationship relied on manual records, doctor’s memory, the familiarity with the patient and a continuity of care. Now the multifunctional team means that the patient is likely to see more than one doctor at a large clinical practice, and that a nurse practitioner may also be a participant in the patient’s healthcare. The coming of an electronic patient record, while perhaps improving the communication between the different healthcare providers, will only encourage the likelihood of more participants; the benefits offered by continuity and familiarity will be lost. Wilks posed the question: do we know what this will mean in terms of the quality of the relationship between patient and doctor? He said that as long as the patient was the focus of interaction and not the electronic record itself then the change may be beneficial.
Wilks talked about the obvious dangers of tobacco and poor nutrition (both excess and deficits) but talked about the interesting effect of alcohol – positive in moderation and problematic in excess. He pointed out that there are different hazards with alcohol in different age groups – that young men aged 18–24 appear to have a linear relationship between alcohol and health hazard because the main risk in this instance is the acute effects of alcohol – increased risk of driving accidents, violence and harm due to the intoxication. The role of the doctor in this case is difficult; it is hard to persuade this age group to decrease their intake. This is a different relationship than the one of typically older age groups who drink heavily – to a certain point the relationship between alcohol intake and hazard is linear, but beyond a particular limit the damage becomes disproportionately large for a small increment in intake. In these instances the doctor must focus on moving the patient to an intake below the change.
Wilks spoke about the change in ice cores indicating without doubt that we are on an exponential curve for global warming – he felt the change was inevitable given the current climate. He said that the increased temperatures would lead to changing patterns in infectious diseases, and heat-related mortality would increase dramatically. In 2025, given the current rate of change, that the average temperature in the EU would be the same as the most extreme temperature experienced in France in the last heatwave, that killed a record number of people from heat-related problems. Increased drought, more frequent and more serious natural disasters (tsunamis etc) will again alter the doctor’s workload and relationship to his or her patients. He pointed out that we currently have all the technology we need to prevent this happening, and that 1% of current GDP would at least stabilise the climatic change; but this is unlikely to happen. It was a sobering and intriguing perspective on an ecological problem that appeared (at first) to be unrelated to healthcare.