Medicine, Philosophy and the NHS

A book by a doctor and philosopher has caught my attention. It’s called Hippocratic Oaths: Medicine and its Discontents by Raymond Tallis The Times printed several large extracts from the book. In the first extract, provocatively entitled ‘How Patient Power Could Kill The NHS’ the ’eminent consultant and noted philosopher’ (the words of The Times, not mine) makes a good case to show how consumer rights and ‘patient power’ is making us lose respect for doctors and undermining the profession in a way that will inevitably lead to lowering of medical standards.

The way this happens is simple. The patient becomes more of a ‘client’, ‘customer’ or ‘consumer’ as the special qualities of the doctor-patient relationship are stripped away by people who know next to nothing about medicine. Doctors then have to focus on one thing. Self protection. In short we will become well-paid automatons who deliver service with a smile – albeit a smile that is somewhat less than authentic. Tallis correctly alerts us to the danger of this, saying that when ‘disrespect for the profession’ is combined with an ‘attitude of hostility towards their physicians, it will further reduce the goodwill of doctors’ and ‘make them less willing, perhaps, to go the extra mile’. This is a huge point and I totally endorse it. Medicine should never be allowed to be degraded in this way. We, doctors, should always have to answer to our conscience as well as to the guidelines of well-meaning and wise authorities, such as Hippocrates, for example. When the demands of our consciences become totally subservient to the needs, financial and others of ‘higher authorities’ this profession will be in very serious trouble, to the detriment of those we were honour-bound to put first – our patients.

Tallis makes his point in spades when he compares the health advances made by doctors in the last 50 years to those made by government. Both are vitally important, of course but here is the comparison.

Doctor-led advances in Medicine: (and this is only a sample from Tallis’s list)

  • Surgery: joint replacements, bypass ops, transplants and fertility treatments
  • Drugs: to treat: hypertension, killer infections, high cholesterol, stomach ulcers and cancer.
  • Other Treatments: Dialysis and machines that break up kidney stones.
  • Tests to Diagnose: Among many others, MRI scans, ultrasound and cardiac catheterization (a method of getting detailed information about what’s going on with your hearet)
  • Medical Services: Appointment times, admission wards, day surgeries and home-based hospital care

Government led Innovations:

  1. Expensive reorginasation of the whole service by each new government. The huge cost and effort do not justify the small improvements and there has been much deterioration as well.
  2. Fewer hospital beds and longer waiting lists for ‘non-urgent’ treatment.
  3. Target setting for waiting lists while simultaneously restricting resources including available beds.

This is a timely publication and the good doctor has much wisdom to share about the crisis in health care in this country.

Recommended reading even though he attacks alternative medicine – somewhat irrationally in my opinion. (See next week’s article)

Title: Hippocratic Oaths: Medicine and its Discontents by Raymond Tallis
Publisher: Atlantic Books
Price: �19.99