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VIEWS & REVIEWS: Richard Hayward Why the culture of medicine has to change BMJ 2007; 335: 775 [Full text]

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Change yes......but incrementally!

peter j mahaffey   (13 October 2007)

Re: Change yes......but incrementally!

Sam Lewis   (13 October 2007)

Change yes......but incrementally! 13 October 2007
peter j mahaffey, consultant plastic & reconstructive surgeon bedford hospital Send response to journal: Re: Change yes......but incrementally!	Any analysis of the present woes of the UK medical profession from a working clinician (rather than medical or government politician) is a breath of fresh air in an environment where most of us seem to have been cowed into submission. And Richard Hayward is absolutely right to focus on what it is that spurs a doctor to enjoy his or her daily work....to solve a problem by using one's skills, with beneficial fall-out for patient, doctor and health service. But after that, his analysis breaks down. The stimulus for the massive changes in our NHS were 'local' (getting down waiting lists etc) and 'big-picture', ie grappling with the spiralling health costs which have afflicted all nations. But the problem was not 'the culture of medicine' which, as Hayward defined, is about the self-gratification involved in diagnosis and treatment. Rather, it was the government of the day's error in inflicting repeated, wholesale, brutal changes to a complex ecosystem which had evolved over 60 yrs since 1947. No system could ever have withstood such an upheaval. All that was really needed was for wise government to make progressive nudges to the tiller. For better or worse, clinicians are far and away the best educated section of the NHS workforce. If someone had simply come to them and said "Look, what do you need to get your waiting lists down to a managable length?" they would have done it, and at a cost of one hundredth of what has been spent in the past 10 years. Moreover, doctors mostly also enjoy efficiency, and a similar direct appeal to them to 'help us get our budgets down for the good of us all' would very likely also have appealed to those self-same qualities. But now the damage wrought by those seeking to weaken the profession is too great. And we are almost in the end-game where the politicians need only to wrest the last powerful card from our hand, the doctor-patient relationship. Infection crises, generic referrals, clinical guidelines, repeated 'fat-cat' allegations.... and soon we will be fully fledged state employees just as in Scandinavia! And then perhaps the state will realise that it wasn't the 'culture of medicine' that lost it the priceless asset of an independent profession. Competing interests: None declared
Re: Change yes......but incrementally! 13 October 2007
Sam Lewis, GP Surgery, Newport, Pembrokeshire, SA42 0TJ Send response to journal: Re: Re: Change yes......but incrementally!	I am busy writing a short piece for my 'Policy Analysis' course, contrasting the 'rationalistic' with the 'incrementalist' approach to decision-making... and then you come along , Richard, with a proposal that takes my breath away with its rational and incremental simplicity :- [ask the clinicians] "Look, what do you need to get your waiting lists down to a managable length?" - they would have done it, and at a cost of one hundredth of what has been spent Wow !! Didn't Gerry Robinson ask exactly that ? and didn't he hit a wall ?? so tell me Richard, how is it done ?? Competing interests: a doctor and a taxpayer