Whilst each patient usually understands they will have an individualised treatment plan they are often not so used to the idea of an individualised follow-up strategy. There are many permutations between the every 6 months for life dental model and the ‘just see me when you are too ill to treat yourself’ option. In practice, it is often about the sort of ‘health’ an individual wants to experience: for some patients it is the absence of the worst symptoms they first presented with; for others it is getting rid of all their symptoms and not suffering a relapse; whilst others seek a positive feeling of well-being.
For patients who have consulted for advice on acute conditions a follow-up is only usually necessary if there are other underlying symptoms or susceptibility, for example, a patient with acute back pain that is found to have an underlying postural problem. For patients with recurrent acute problems or a history of frequent different health issues (for example, recurrent cystitis or chest infections) an occasional follow-up until the symptoms have been clear for a time is sensible.
In patients with more long standing histories of chronic illness it can take some time to complete treatment. I usually advise we gradually reduce the frequency of appointments. Whilst we recognise the challenge and cost of continuing with treatment, if it is stopped too soon it is often the case that symptoms return in one form or another.
In patients with very deep-seated illnesses or multiple co-existing illnesses (many of my patients present with five or more different chronic diseases), follow-ups once health is improving are ideally governed only by what is best. This is determined not just by patients’ residual symptoms, but also their constitution and circumstances.
There are many factors that influence the speed at which we extend the interval between appointments. They include not just those already outlined but how patients feel generally in themselves: do they have more energy or vitality; have they rediscovered their normal life-balance; are they able to do things they want to do? One sign I am increasingly recognising in patients who have successfully followed a course of treatment is that they report finding new levels of creativity, and those around them comment on improved relationships. Whilst being well does not mean never getting ill, it does mean adjusting positively to life’s changes and challenges, and not getting symptoms that persist or re-occur. What I look for are signs of a healthy constitution more than the absence of symptoms
Of course we do realise all this needs to be tempered with what is practical. We recognise that we will only see some patients again if there is a recurrence of an existing condition, or a new problem. Whilst this is fine try and remember two things: firstly, the time it takes to return back to your healthy state is proportionate to how long and how severe the relapse is; secondly, even though you have relapsed it doesn't mean that the treatment didn't work first time, just that it possibly wasn't completed. Ultimately it is your choice, but my wish for you is that you would not be one of those patients who thinks less about finishing treatment than about starting it. Invest in your health as well as treating your illness.