The Crisis in Commitment
'We are hounded with targets, harassed by diktats and prevented from giving patients the time they need.'
The crisis of caring and the crisis of costs are two sides of the same coin.
But medicine faces an even deeper crisis. With its place in society changing rapidly, medicine is losing the authority and respect it once took for granted. At the same time, today’s mechanistic view of healthcare is threatening its once unquestioned benevolent values. There is an ambivalence in medicine now that is quite new. On the one hand, we laud evidence-based medicine and pretend it has all answers, when the mere existence of long-term disease confirms it does not. We pretend doctors are still the VIPs of healthcare whose judgement is paramount, despite the evidence of every day experience – and the renegotiated consultant and GP contracts – that most are in thrall to a management who are instructed that their raison d’être is financial targets.
We claim it is a profession characterised by compassion when doctors – and nurses – at Mid-Staffordshire and elsewhere have admitted they were too intimidated, too frightened for their jobs and careers, to speak out about standards of care that would disgrace a 19th century workhouse.
Then there are the patients. Not all are nice people, grateful for doctors’ attention and skills. There are those who demand unnecessary treatments, sometimes aggressively, claiming they have 'rights'. Many look up their symptoms and diagnoses on the web and end up with information – if not understanding – that is embarrassingly new to their doctors. Others persist in lifestyles we know will end up crippling them, in the face of all and any advice. ‘Ungrateful’ is one of the milder descriptions clinicians use.
Pinched between the painful trinity of awkward patients, the mechanistic industrialised system that is healthcare today and almost daily media criticism of everything they do (and how much they are paid for doing it), health professionals are hounded with targets, harassed by diktats and prevented from giving the sick patients the time they need. It is no wonder so many doctors and nurses say they are unhappy, feel demoralised and undervalued.
Most people go into medicine and healthcare because they want to care. They want to help people who are sick and suffering.
Yet compassion and commitment are losing ground because the system – and the modern paradigm in medicine – cannot easily measure them. There are no targets for caring. There are no quantifiable biochemical actives. The tacit assumption is that once people become patients, they are nothing more than biochemical machines it is the doctor’s job to fix.
Of course clinicians lose their sense of commitment when compassion and caring are devalued and meaningless. No amount of high tech medicine, no matter how brilliant, is going to cure this. Nor is abolishing primary care trusts. Whatever failures might be laid at their door – and there aren’t as many as some think – they were symptoms of a broken system, not its cause.
People - both patients and professionals – are much more than biochemical systems, so we need medical science to fully embrace the psychological, the social and the ecological as well as the biological. And we need an NHS based on compassionate professionalism and engaged service users. An NHS that creates health with its patients, not in spite of them, and encourages informed choice and decisions. That will re-ignite the commitment and vocation we are in danger of losing.
There is one bright spot on the horizon. The government has recognised the crisis in healthcare. The White Paper, 'Equity and excellence: liberating the NHS' talks about devolving power from Whitehall to patients and health professionals.
It promises that the NHS will live up to the principle of 'nothing about me without me'. It pledges that improving the quality of care will be the main purpose of the NHS. That professionals will focus on improving health outcomes, while patients will have better information, choice and control.
That services will be designed around patients, rather that patients having to fit into whatever is convenient for hospitals, surgeries and community services. If this vision becomes reality, then the crisis in medicine can be solved.
The College of Medicine will do everything in its power to help that happen.