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The really inconvenient truth in the world of healthcare and medicine will never go away: it's run by people, for people, and ‘there's nowt queer as folk.’
Throw our less appealing human tendencies (in part summed up as reluctance or inability to imagine how life might be for others) into a melting pot with professional bureaucratic strangleholds and patients who don't feel great, and what better recipe for trouble?
Some fantastic doctors give good care in a tough climate, some assiduous managers try to ensure what they offer is properly run and allocated. And we're inconveniently imperfect patients. Those 20 million appointments every year we don't attend or cancel, those healthy diets and exercise programs we don't follow, our reluctance to accept the reality of limited resources. Sure, the system can and does let us down appallingly at times, but we too need to admit that, however much we want to see the doctor, and now, to get some treatment we saw on the internet, (a) there may be someone more ill who must go first, and (b) they need an expensive life-saving drug more than we need asparagus suppositories.
While recent research reveals that patients think they're lucky (albeit unusual) in having good dealings with the NHS (Lost in Translation, NHS Confederation, 2006), a couple of years ago, combining an NHS post with journalism and interviewing countless professionals and patients, I kept hearing the same question: where has the humanity gone?
Patients were at a loss, professionals cited bureaucratic burdens. I wrote a book about the mess, rolling the words of many real doctors into a fictional one, who says: ‘Pointless tasks, meetings, counting games. You can give me an abacus, but I can't promise you sweeter medicine.’
Surely—and we need to ask this, for want of an evidence-base that mushrooming management gives us a better time if we get sick—sweeter medicine is about that extra ounce of humanity? And finding it, even when, as a doctor, you've just had a row about targets, budgets and how much red tape you need to wrap it up in. Or when, as a patient, you feel dreadful and the system's apparently conspiring to make it worse.
While it is naïve to suggest curing the NHS's ills by being nicer to each other, it's surely part of the picture, and it keeps getting buried under rarefied rows. We need to work together, hard and fast, to claw back tender, loving health care before losing sight of what it is. Getting better is about people, not about politics, professional posturing and pride. Well or ill, we're in this together. Counting games may be a necessary part of the picture, but so too is stepping back, little and often, and asking whether we're treating each other well. Some days, that feels like the last achievable thing on earth. Surely it always has to be the first?
Competing interests These views do not necessarily reflect those of the AMRC.