Dr Phil Hammond, GP and broadcaster

The NHS was founded off the back of the Second World War, and the current political and healthcare situations are giving me a feeling of d³jö vu – now, as then, doctors are facing huge changes in the way they work.

Back in 1948, the new health service relied for its success on the prevailing spirit of stoicism. Since then, we have made huge advances in medicine, but many have depended on the patientsÍ Dunkirk spirit. The learning curves were steep, and dozens of patients laid down their lives for the greater good by undergoing pioneering surgery.

The present post-war period differs from the earlier one in that we are all much less willing to tolerate casualties resulting from either surgical learning curves or battle.

But just as iatrogenesis takes a heavy toll, so does friendly fire, and as the weapons get bigger, so does the potential for harm.

As Sir Cyril Chantler put it: ñMedicine used to be simple, ineffective and relatively safe. It is now complex, effective and potentially dangerous. The mystical authority of the doctor used to be essential for practice. Now we need to be open with our colleagues in healthcare and with our patients.î

Both war and healthcare – or at least the politicians at the helm ¿ have a nasty tendency to create false expectations. The ñliberationî of Iraq was never going to be bloodless; nor did we come anywhere near achieving the WHOÍs vision of ñhealth for allî by 2000.

And nobody believes Tony Blair when he promises to turn round the NHS by the next election. No wonder the Government is having trouble winning over the hearts and minds of doctors.

The law of diminishing returns applies to both medicine and weapons. Funding of the NHS has increased twenty-fold since its inception, but weÍre not twenty times as healthy. Nor has the proliferation of weapons made us any safer.

No country can afford the best technology to care for all its population – and that may not be a bad thing. There has never been much correlation between the amount of money poured into acute health services and the general health of the population.

In fact, Professor Chris Bulstrode argues that we need fewer doctors, not more. ñMore doctors just means more illness. If we want a healthier and happier country we should get rid of a lot of doctors.î

Medical discourse is littered with war-speak. We fight and battle disease, and talk longingly of ïmagic bulletsÍ.

The image of doctor as shining knight has been tarnished by assorted scandals, but most of them serve to prove that doctors are human and make mistakes under pressure. The same can be said of soldiers.

  • Dr Phil is back on tour with 89 Minutes to Save the NHS. Details at www.karushi.com

Guidelines in Practice, May 2003, Volume 6(5)
© 2003 MGP Ltd
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