Monday, 29 August 2011

Going with the grain in this world of change


An extract from an Eric Schmidt lecture was published in the Guardian on Saturday (http://goo.gl/2VHVx). As chairman of Google, I imagine he has become used to being listened to, but he also makes some points that are worth listening to.

He got me onside straight away by bemoaning the demise of the polymath, and actually went as far as criticising the British educational for polarising us in to two camps - the boffins and the luvvies. This struck a chord with me, because although I am no Renaissance man, I would have liked to study English, history and Latin at A-levels, but decided on Maths, Chemistry and Biology for two reasons: firstly I wanted to become a doctor, and secondly the school that I was act required all of its students to continue to study literature, history, art and a bit of philosophy regardless of what they had decided to specialise in. This latter fact made giving up subjects I enjoyed a lot easier.

These days, my preference for the arts and the humanities usually manifests itself with me wibbling away on a ward-round, in a rather supercilious manner to disinterested colleagues, who would really rather focus on the much more important matter of getting patients better. I also have a policy of requiring medical students attached to the firm I work on not to be in the hospital on Wednesday afternoons: for many students this is the day they play university sports matches, but for those who don’t, I tell them that Wednesday afternoon is their chance to do something else. It doesn’t have to be sport, but it should be unrelated to medicine.


Much of this emphasis on learning outside medicine, is I think, actually underpinned by certain amount of intellectual snobbery and personal preference. Having spent some time over the last couple of days mulling the matter over, I think that I have a tendency to over-emphasise the value of a good knowledge of the arts and humanities in doctors, simply because they are subjects that I enjoy. It is nice to think that your doctor is urbance and debonair, but it is far more important to have a doctor with a good technical knowledge, and a healthy amount of humanity about him. A desire for a cultured or artistic doctor has something of the James Bond illusion about it: for someone to be that well read or talented at something else means that they must have found medicine so easy that they had lots of time left over for their extra-curricular activities. Of course, it would be equally valid to assume that they only had time to practice the guitar or karate precisely because they spent too little time studying medicine.

The only way to tell if your doctor is any good is to establish what investigations and treatment he recommends, and to weigh him on the way he communicates this information to you. What he gets up to in his free time should be irrelevant, as long as it doesn’t prevent him from being up-to-date.

But this brings me on to another point one often hears uttered in the corridors of hospital, usually under the exasperated breath of be-suited, middle-aged consultants, who exclaim that modern medical students learn how to communicate, but do not actually take the time to learn any medical knowledge worth communicating. This of course is nonsense - medical graduates have always needed supervision and support, the only difference is that today they are able to ask for it and expect to be given it.

Future consultants will probably have a narrower field of expertise than previous ones, because of the increasing technical complexity of medical practice, and also because young doctors do spend less time in hospital than they used to. This is not a bad thing - we used to be a profession in which it was acceptable to allow junior doctors to practice unsupported, exposing both those doctors and their patients to unnecessary risks. Junior doctors can now look forward to a training programme in which their educational requirements are set out before them, and they are supported and assessed as they go along. This will result in doctors who will be better trained in the skills that they use everyday, and will be able to demonstrate how this competency was achieved. This should be reassuring to both patients and doctors; the price we pay for better training will be the requirement that each doctor (particularly surgeons)  will have a narrower range of skills and procedures that they are trained to do.

The way we train doctors, and the way we interact with patients makes for a different world of medical practice. This is reality. We cannot change this, and we must work out the best ways to offer the best quality and best value healthcare within the confines of the world that exists. Many of the factors underlying these changes are in themselves positive - we should applaud ourselves for arriving at a place where junior doctors are no longer working 100 hour weeks, and we should be congratulated for adapting medical education to be more accountable and thorough. There were a number of cock-ups along the way, and there are a great many issues that need to be ironed out, but that should not distract from the idea that we have ended up in a better place than we used to be. And this brings me back to Eric Scmidt - in the new world of on-line media, he argues that policy makers should go ‘with the grain’, and find new ways to offer the protection that is needed in a way that does not stifle innovation. Exactly the same is true of healthcare - we should not be dismayed at what has changed, but rather embrace it, and see it as the opportunity to improve education and patient care that it is.

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