n=1: Some challenges and opportunities for integrating patient care

Abstract

I AM A JUNIOR DOCTOR working in a Brisbane hospital. I recently completed a PhD investigating the use of eHealth strategies to improve community access to relevant health information, with a particular focus on low socioeconomic communities and their needs.1 Like many products of the postgraduate medical course, I came to medicine after studying other disciplines ? economics and government as part of a Bachelor of Arts, and medical sciences as part of a Bachelor of Science. I?ve long had an interest in policy, and after several years of communitybased field work in a community with an average household income of $25 000, and two years of hospital-based clinical experience, I have come to realise that the health system fails to integrate services to provide a systematic approach to dealing with patients? needs. In this n=1 I outline some of the deficiencies I encounter in everyday clinical practice, from admission to discharge, and beyond, to community- based care. Let me make it clear at the outset that I believe these deficits do not arise from a lack of compassion or care on the behalf of dedicated clinicians and hospital support staff, but rather from a system failure. Indeed, in my own experience, most health care workers give too much, to the detriment of their own health and quality of life. Some of my comments are supported by ?systematic research? (fieldbased observation and survey data), while others come from my own daily encounters.