The tick box approach

I have found that many people complain about the tick box mentality that is just not good care. They have felt that people are just ticking the boxes to cover their own behinds and really the people such as doctors or nurses don’t really care at all nor are they giving good care that will result in improvement in peoples conditions.

That many are under the impression that there is no rhyme or reason why staffs are doing this except that they were asked! Well quite frankly if a doctor or a nurse is telling you that the reason they are doing something is because they have been asked to do it then I would ignore them and would also wonder if they were in the wrong career.

The tick boxes were put there for a reason. It might not always be obvious or make a whole lot of sense on first but there is a reason.

I may not agree with all the tick boxes and certainly I am not saying that this is a good idea in all areas of care but for me tick boxes have a place. 

For instance what are screening programs if not tick boxes? What are the yearly health checks if not tick boxes. I’m guessing most of us don’t object to these tick boxes as they could catch cancer, heart disease or other conditions early and improve our lives but the question of whether tick boxes are appropriate for mental health is a thorny issue.

I certainly have fewer problems with tick boxes than most and I put this down to the fact that I have never been hospitalised, have made judicious use of reminders to take medication, renew prescriptions and get blood tests done and really my expectations of a busy GP are not as high as many. For instance I do not feel that my GP doesn’t care just because it takes a yearly reminder to have my Cholesterol tested and take my weight. As it happens my GP does far more than weigh me, check cholesterol and blood pressure that most people get. I also have kidney function, thyroxin level, liver function and a full blood panel, just to be sure. That she considers it a bit of a palava is more to do with the fact that she has a deadline rather than because the checks aren't important and I know this because I asked.

The reality of problem is in how often she sees me now that I am not so ill anymore and that really she gets a reminder when I come in next and often this is because of something unrelated and therefore she feels that running a list of tests when I have flu or a cold or a back problem seems a bit of an ask and I’m quite amenable. Not many people are.

However it comes down to this, that it is not appropriate for all things and too much reliance on a system of simple yes no answers will not give good care or result in progress towards good well-being.

Why is this?

Well quite simply mental health issues are about how you feel and the only person who can tell you that is the patient and communicating with people who are very scared, defensive, confused, and in great pain is not straight forward. If a patient is struggling to know what is going on then explaining this to someone else is far more difficult than saying your heart is racing, or your leg hurts. It is so complex that often there is no way to say all that needs to be said particularly when there are so many reasons why people do not want to admit to what is going on.
It seems self evident to me that if the person is having such problems that have turned to illegal drugs, alcohol or starving themselves, throwing up or even in pain then talking to someone about what is going on is going to take a lot of time. Equally the amount of overlap between conditions and the possibility of co morbidity (more than one condition) complicate things even further.

So if it really isn’t good care then why do people want to use them so frequently?

I feel it’s really simple, because people want easy to understand targets that they can compare with previous ones so they can assess whether things are improving or not. Of course there is a certainly amount of making sure that the basics have been achieved, i.e. medication is taken, patient is awake, has eaten and so on but often the tick box is about monitoring and not about the total overall care effort. It is so sad that people are missing this.

In fact I feel that so many people are missing that tick boxes are not all bad as much as they are that tick boxes are not all good either. A little balance please.

In so many ways I wonder if people really do have a handle on when it is good and when it is not and really do wish that people would not get so angry about the idea instead of it’s implementation. If all you do is tick boxes then you’ve got it wrong because there is always more to understand about how a person is feeling. There is always more to learn about what is going on in a way that in physical health there isn’t so much.