Category Archives: medicine (profession of)

UK physicians are no different from auto assembly workers

Screen Shot 2016-05-04 at 07.55.09Junior doctors in England, writes Dalrymple,

and increasingly senior ones, are now shift workers.

This means

there is no continuity of care, or very little, in British hospitals.

There is, of course,

no better way to ensure that young doctors do not believe themselves to be members of a profession with a glorious tradition than to turn them into clock-watchers, and patients into parcels to be handed on to the next person once the music stops.

Screen Shot 2016-05-04 at 07.28.57Doctors have become

production line workers, no different from people who work in car factories.

Doctors turned spin doctors

Young doctors in training are aware of

the importance of spin-doctoring, for they have prepared ‘personal statements’ to get into medical school. It is an exercise in unctuous insincerity.

A lifetime of this kind of thing

will warp any character, and render it simultaneously self-righteous, politically correct in expressed views, unprincipled and ruthlessly focused on personal advancement. People with such character will be easy to herd and control.

Why is the urge to herd and control so strong in the political class? Perhaps, says Dalrymple,

it is the result of an inner emptiness and lack of deeper culture.

The result is

a soft and creeping totalitarianism.

May my surgeon be human-hearted

Screen Shot 2016-04-04 at 08.49.19Dalrymple points out that the media’s attitude towards medicine

swings between lauding a miracle cure and excoriating the murderous incompetence of doctors, leading to a dialectic between unfounded hopes and hostile suspicion.

Yet very occasionally it perhaps ought to be acknowledged that medicine,

for all its deficiencies and the carping of its critics, is a noble enterprise.

Doctors must act

in the absence of definitive knowledge. Sometimes this leads to tragedy, sometimes to triumph.

Screen Shot 2016-04-04 at 08.20.47A paradox

Everyone who comes under the knife

wants his surgeon to be as highly trained and as experienced as possible: but how is the surgeon to come by that training and experience unless he practises on people while he is untrained and inexperienced? Someone has to be operated on by tyros, even if they are under the supervision of more experienced surgeons. In practice, for compelling practical reasons, that supervision may be light: senior surgeons cannot be everywhere at once. What is true of surgery is true of other specialities: decisions of vital importance to individuals are taken by people who are still learning.

In the old days,

Thomas Rowlandson, 1793

Thomas Rowlandson, 1793

perhaps explanations of treatment options were less elaborate or full than they are today, but they were still given and consent to such treatments was still sought.

Patient autonomy as the single most important guiding principle of medical ethics has drawbacks.

Patients who are very ill are often in great pain, or severely weakened. Their concentration is poor, they may be irritable or in a state of panic. This is not generally the best moment to ask them for a reasoned assessment between two or more alternatives, each with its own advantages, side-effects and chances of failure. The insistence that they do so is often a form of disguised cruelty.

Dalrymple says that when he has been seriously ill or injured,

I have wanted my doctors just to get on with it as best they could, without any interference from me. So far, at any rate, my confidence in them has not been misplaced; and the paradox in the doctrine of autonomy is that the person may — in fact, often does — wish to abrogate it.

Surgeons

need human as well as technical understanding, and kindness is at least as important as respect for patient autonomy.

Who on earth would want to be a doctor?

Screen Shot 2016-03-24 at 21.04.40Dalrymple points to the

steep decline in the attractiveness of medicine as a vocation, profession and career.

And no one

who ever experienced an ordinary Soviet hospital will be in any doubt as to what a decline in the prestige of the profession meant to patients.

It has long been the goal of the government, he points out,

to deprofessionalise medicine and to turn its practice into a mere job. An independent profession, with its high standards and old traditions, is dangerous to the government, especially when it is as respected as the medical profession, in a way in which a mere group of shift workers will never be. Shift work dehumanises patients and deprives the work of most of its satisfaction. It is also grossly inefficient.

The independence of doctors

has eroded almost completely, and you cannot expect highly educated people who have undergone a long and strenuous training to remain contented for very long with being harried and reprimanded by people who are of lower calibre than themselves.

A vivid exemplification of the New Hospital Order is the noticeboard in the corridor of the hospital in which Dalrymple works, which

informs the public of the senior staff of the hospital. The senior consultants, all men of considerable distinction, appear on the fifth and bottom row, under four rows of bureaucrats. The impression is given that they are of very minor significance.

The shortening of training,

both graduate and postgraduate, is another straw in the wind. New hospital consultants do not have the breadth of experience that old consultants had at their appointment, and this is because doctors are increasingly regarded as technicians and nothing more.