The importance of time and narrative.

A personal view and aspiration for occupational medicine – By Dr Alex Swan

In recent years it seems to have become increasingly common for many patients not to know the name of their general practitioner or indeed know whether they have a general practitioner. The changing face of general practice has led to patients having less time to be understood. It is my experience that when we see patients in our occupational health practice it is often the first time that they have had the time and opportunity to tell the full story.

It has been well known for many years that there are many factors that play a part in a person’s experience of symptoms beyond the traditional biological model of medicine. The biopsychosocial approach recognises the complex interaction between the body, the mind, and the overall social context.

It is the time that we have that is so lacking in the NHS which I believe allows us to have a unique position in understanding a fuller context of the patient experience; being able to take a holistic view and hopefully assist all parties, both employer and employee in firstly gaining a fuller understanding of the situation and secondly in providing practical recommendations.

It is with great sadness that I often see people with chronic pain managed by multiple ineffective medications interspersed with occasional injections whilst evidence-based approaches to the management of chronic pain is unavailable. This often leads to the patient becoming a victim, incapacitated, in despair with lost years of failure to achieve life dreams or potentials. The problem with functional pain management programs and psychological support is that this takes time and effort and the easiest option for the hard pressed, exhausted and overworked physician is to add further medication and continuing to sign the fit notes. It has to be acknowledged there has been a lack of investment in the UK in evidence-based chronic pain management and that these services are often not available locally.

We are in a unique position where we can use our influence to ensure safe and healthy workplaces allowing individuals to flourish and achieve their potential. It is the time to listen and understand the narrative that allows us to gain a greater context with regard to the physical, psychological and also the social and lifestyle factors.

So having the time to undertake a full, holistic assessment taking into consideration our detailed knowledge of the work environment, can make a difference not only to the individual but ultimately to some of society’s current ills.

This I believe places occupational health clinicians in a unique situation to help the working population. Wouldn’t it be great if we were able to help more employers particularly SMEs and the out of work population similarly?  

Medigold Health