25 October 2012

Stuart Patterson Lecture 2012

Dr Clare Gerada has kindly allowed me to post a link to a pdf of the full text of her recent speech to the Australian RACGP Conference: What is wrong with Health Care: The 3 Ms

If you have any concerns about what is happening to our NHS and the way doctors are being turned into automatons doing the computer's bidding, this is a speech for you.


Anonymous said...

Yep. Agree with that. But there is much more to it. The rot had set in long before the appalling health care bill.

What factors contributed most to the destruction of the NHS? It's so easy to assume that it is overt/covert privatisation, but there are more damaging but less obvious factors underlying. Dr Grumble's points about the modern lack of inter-professional relationships and, indeed, camaraderie are potent markers of the disease in the medical body politic. The most important member of the hospital medical team, the houseman, has, without the old-fashioned 'firm', been cast adrift and rendered powerless. He was the one who knew when the patient had come in, knew what tests had been done and, most of all, knew where the patient was. He was at the start of his career and was learning how to care. Now he doesn't know he needs to care. The consultants meanwhile are hunting for unclerked patients scattered throughout the hospital, and attempting to collate random eclectic tests done by a succession of inexperienced doctors, none of whom has taken an overview of the patient. It's not good use of a consultant physician/surgeon's time. GPs, for ever the whipping boys, have chased their targets and now are being forced into a management role that few of them (safe for the usual flotsam and jetsam of the profession who always appear when there is a committee to be formed) want. Want it or not, they will do it, and then they will be crucified in the Daily Mail when, as it will, the money runs out. The internal market, foisted on the NHS by Thatcher, then in thrall to US economist Enthoven, did irreparable damage. Add in the European Working Time Directive, a pinch of MTAS and the young doctors start to leave the country or the profession. A cash-strapped government attempts to 'replace' doctors with protocols. Write a protocol, and a monkey can practice medicine. And you can hire ten monkeys for the cost of one doctor. Intelligence, compassion and original thought no longer required. Thus the Liverpool Pathway hits the news because it is protocolised euthanasia allowing the care of inconvenient patients to be passed down the skills escalator to a clip board carrying health care 'professional'. And that's just the protocol in the news. There is far worse going on but it's not dramatic enough to come to the notice of the Daily Mail. Meanwhile, transparently decent professionals like the Jobbing Doctor who know how to provided skilled and compassionate care to the very ill, but these days are less and less likely to be asked, are counting the days to retirement.

There. I feel much better for that. But I wouldn't really have want to be a tabloid journalist.

Dr Grumble said...
This comment has been removed by the author.
Dr Grumble said...

I could have written that comment myself.