Mark Duman

MARK DUMAN
Director, Intelesant.
Non-Executive Director,
Patient Information Forum

Mark Duman
Mark Duman

Why am I Proud to Work in Healthcare?

A while back, when I was working as a full-time pharmacist, I shared my frustration with colleagues that all we ever seemed to do was dispense medicines. I thought that we should play a greater role in our patients’ health, especially given our 5-year training. Along with supplying their medicines we should be coaching them in looking after themselves and making better choices for staying healthy.

I have been interested in how we can improve health on a national scale for a long time. After a few years in pharmacy I joined The King’s Fund, a charity that works to shape health policy and practice. We supported several projects piloting the practice of ‘shared clinical decision-making’, which promotes the concept of patients and health care professionals working together as mutual experts. Later I, with others, founded the Ask About Medicines campaign which ran between 2003 and 2009. It encouraged patients to openly discuss any issues they had about their medicines. We wanted to improve communication between patients and healthcare staff, and we did this by equipping people with potential questions to ask about their medication. Ultimately, we wanted it to become the norm for people to discuss their prescriptions with their healthcare providers. We ran an annual Ask About Medicines Week, each with a different theme, and over the years produced a huge bank of materials to help clinicians and patients communicate better.

We wanted to improve communication between patients and healthcare staff, and we did this by equipping people with potential questions to ask about their medication.

Another public health project that I worked on was the BBC’s Fighting Fat, Fighting Fit campaign, which ran in 1999. This multichannel broadcast campaign explained the benefits of a healthy weight, and gave dietary and activity advice. I think it’s important to tackle healthcare on this scale. Demand for NHS services is limitless. Matching supply to demand will take a joint effort from society, industry, healthcare providers and patients/ citizens themselves.

I am a big believer that information underpins patient engagement. Information, in its broadest sense and not just leaflets, should be regarded as a therapy, or intervention, in its own right. Evidence shows that helping patients to understand their health problems often makes them feel better. We must make it much easier for people to access and use health information – there’s lots about but it’s provision is not integrated into health care services. Patients often need to go looking for such information and support – putting up a leaflet rack is not enough!

Five years ago I was diagnosed with type 2 diabetes, and I found it really difficult to get hold of information about it that addressed the issues I was concerned about. I wasn’t offered a place on DESMOND, a structured patient education course that teaches patients about the disease and how to manage it. I did do the course eventually, but I had to talk my way in. Most patients wouldn’t even know it existed and would miss a wonderful opportunity to improve their life with the condition.

In my opinion, staying healthy should be seen as a responsibility of citizens. We need to do more to change social norms around unhealthy behaviours. This has happened before: we managed to make it the done thing to wear seatbelts and brush our teeth twice a day, and you’d be surprised now if you found someone who doesn’t do those things. We need to make it normal to make healthy choices when it comes to diet and activity, to the point where it’s odd if someone doesn’t. Of course, people have to know what the healthiest choices are, so we must also do more to educate people about their health; starting in schools, and also using public health campaigns. But knowledge isn’t power — not on its own — and knowing that, for example, junk food is bad for you often isn’t enough to stop you giving in to temptation. So public health interventions, such as reducing the availability of junk food or making it prohibitively expensive, may be necessary. We should also look to decision theory to help people make healthier choices. I really think that there has been an underinvestment in behavioural science when it comes to healthcare.

I strongly believe that increasing the activation of the population is key to solving the NHS’s problems and it’s great to see NHS England investing in 1.8m ‘Patient Activation Measure’ licences.

On the clinicians’ part, my view is that they must be coaches as well as carers. Medical training still teaches to do things ‘to’ or ‘for’ people, not ‘with’ them. Healthcare needs to be more of a partnership, with clinicians teaching patients how they can help to look after themselves and patients being candid about what does and does not work. Furthermore, they must continue to improve their communication skills, and they should be trained in motivational interviewing techniques so that they can have the greatest possible influence on their patients.

In their turn, patients must take more responsibility for their own health. If I am going for a 15-minute appointment with my accountant, I prepare for it beforehand so that I can make the most of the meeting. When I go in, I know exactly what information I want, which questions to ask, and I have the answers ready for questions that I know he is likely to ask me. I think that patients should do the same for doctor appointments – that way the short time will be more efficiently spent. This interest, knowledge, ability and confidence of patients to manage their own healthcare is now being called ‘activation level’. Patient activation can be measured and it is the most reliable predictor of health outcomes. Across all sociodemographic, ethnic and gender groups, more activated patients do better than less activated ones. I strongly believe that increasing the activation of the population is key to solving the NHS’s problems and it’s great to see NHS England investing in 1.8m ‘Patient Activation Measure’ licences.

I’m now a management consultant and patient advocate, and I must say that working in healthcare is a privilege. I couldn’t imagine going to work in any other sector. Knowing that every day I am helping people get better, or help them to recognise their potential to help themselves, makes me really proud.

You can follow Mark on Twitter here: @MarkDuman