26 April 2008

Tooke for the Tower?

Is Tooke being listened to or is our government so entrenched in its ways that the only hope for the NHS is to throw it out and hope the others can see the light? Is Tooke seen as a heretic or a saviour? Dr Grumble fears he knows the answer.

Here are some quotes from Sir John who was interviewed on Radio 4 recently (with thanks to Sam who pointed the programme out).

Different professional roles require different educational foundations. If you pursue a medical practitioner type of role, then you need a profound foundation in science, you need a deep education to enable you to undertake the clinical reasoning which is absolutely key to diagnosis - finding out what’s wrong with people. If the pattern doesn’t fit, you need to be able to go back to base principles and work things out from a knowledge of the science

On substituting healthcare professionals for doctors:

The results of role substitution experiments are not particularly well publicised, but when they have been conducted they’ve tended to reveal that the role substitutor for the doctor is no more cost effective and indeed in some cases less cost effective than the doctor doing that role. And the real reason for that is that a role substitutor may be able to follow a protocol, but unfortunately human beings and human disease don’t conform very neatly to protocols and that gets forgotten.

Referring to the skills escalator

In combination with a hierarchical control system and loss of clinical engagement on the ground, then it’s not surprising that doctors have felt somewhat de-professionalised and undervalued.

These few paragraphs are packed with Grumble themes. Some of you may remember speculation that Sir John must be reading Dr Grumble. But he probably hasn't. Everybody is actually thinking this way but not everybody is prepared to admit it. So will it be Lord Tooke or Tooke for the Tower? We shall see.


PhD scientist said...

Isn't it time that all the doctors' professional associations, and all the Royal Colleges, and all the doctors in parliament, got together and publically and unanimously said they stood 100% behind Tooke, Dr G? Tooke certainly seems to be prepared to say the things that matter, and in unvarnished language, but it must surely be time for the profession to get behind him, with the press in attendance. I suppose the difficulty is how to back him while not invoking the wrath of all the other "health professions", since the Govt has got a long way on that old Macchiavellian principle of "dive et impera"

But... as you said in another post, with the Govt looking a bit shaky, now might be the time.

Jobbing Doctor said...

Thanks, Grumble, for pointing this out.

Much wisdom and sense here.

Doubtless the Government will use the age old tactics to undermine an expert report as so wickedly shown in Yes, Minister.

Anonymous said...

I am sure Sir Tooke went around reading what bloggers say and used some of information to form his report. This is exactly what a good capable professional must do if s/he is to present accurate and fair findings and solutions. This is why his report is so popular, because it is fair.

I am glad he is not keeping quiet ... no one should!

Not for the towers, if anyone can see sense

Anonymous said...

Even Sir John cannot quite bring himself to the nub of the problem which he talks around. He delicately refers to those who pursue 'a medical practitioner role' and then says that these people require the sort of depth of education that a doctor has had. He hasn't quite said that those who do a doctor's job need to be doctors and that others just do not have the right resources. He would have risked appearing arrogant if he had made his point crystal clear. Many doctors have been so convinced that you need a doctor to do a doctor's job that they have not felt the need to risk shouting this fundamental truth from the rooftop. But we should have. Managers really do not understand just how difficult the process of clinical reasoning which leads to diagnosis is. They fail too to grasp that much of medicine just cannot be protocolised. Didn't you have some posts on the madness of protocols, Dr G?

Anonymous said...

Red Adair had it right when he said:

If you think it’s expensive to hire a professional to do the job, wait until you hire an amateur.