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The danger of treating doctors like saints The public is complicit in dehumanising medics

There is a crisis of wellbeing in the NHS (TOLGA AKMEN/AFP via Getty Images)

There is a crisis of wellbeing in the NHS (TOLGA AKMEN/AFP via Getty Images)


July 3, 2023   6 mins

The idea that doctors are saints is relatively new. For much of the 19th century, they were held in pretty low regard by the general public. Some were seen as social climbers — men using their medical training to get closer to wealthy patrons and pay their way into the middle classes — others as grifters, selling useless pills and nostrums to desperate patients. William Hogarth, in the late 18th century, and James Gillray in the early 19th, showed little mercy towards doctors, making a mockery of medicine in their satirical cartoons.

The 21st century narrative couldn’t be more different. To mark the National Health Service’s 70th birthday, in 2018, Nicklaus Thomas-Symonds wrote a new preface to his biography of its architect, the Labour MP Aneurin Bevan. Like most contemporary paeans to the NHS, Thomas-Symonds’ lavishes praise on its staff, both past and present. “Those who work in our National Health Service have made it what it is today,” he wrote, “and we should always thank them for their remarkable commitment to public service, often carried out in the most difficult of circumstances.”

This view of the NHS, which turns 75 this week, is even more pervasive now than it was then. During the pandemic, politicians, journalists, and patients commended the devotion of doctors with such regularity that it became cliché. Most discussions of healthcare in the UK present NHS workers as heroes, or at the very least unusually committed to their jobs. The recent news that doctors will be taking industrial action this month has been framed by the sympathetic press as a difficult decision made in the interest of patients’ safety. Supporters on social media argue that the medical profession is driven not by personal greed, but by its unwavering commitment to the British public. In February, Jeremy Corbyn repeated a familiar claim: “Doctors devote their lives to the needs of others.” Medicine is not like other professions, the story goes; working for the NHS is different from any other job. Unlike the rest of us, they don’t do it for the money, they do it because they care.

All this seems complimentary. The people praising NHS doctors are sincere, often expressing gratitude for care they’ve personally received. But the insistence that doctors are saints actually does a lot of damage. Not only does it harm medics themselves, it also does a disservice to patients.

The origin of the myth lies in the 19th century, when doctors launched something of a PR campaign to give their image a dramatic makeover. They marketed themselves as different from the quacks with whom they were competing for patients in a busy medical marketplace. Trainee physicians were reminded perpetually that the medical “calling” was very different from that of other professions. In 1890, Governor J. Proctor Knott issued the doctoral address to the graduating class at the Kentucky School of Medicine: “No other calling,” he said, “demands a more absolute self-negation than the one you have chosen. No other vocation — not even the sacred ministration of religion itself — requires a more constant exercise of the higher faculties of the human mind, or a more earnest devotion of the purer and nobler attributes of the human soul.”

By the end of the century, medical organisations had begun to describe their work using the romantic language of heroism. In 1900, surgeon Frederick Treves spoke at the annual meeting of the BMA, using military rhetoric to describe his profession: “So as one great surgeon after another drops out of the ranks his place is rapidly and imperceptibly filled, and the advancing line goes on with the still same solid and unbroken front.”

Despite these efforts, the poor reputation of doctors survived into the 20th century. In 1937, A. J. Cronin published his novel The Citadel — an attack on self-serving healthcare professions. He particularly targeted those at the top of the medical hierarchy, the “grandees” whose driving concern was money, and who encouraged illnesses in their “wealthy, idle, hypochondriac, and mostly female patients”. The Citadel was an extraordinary success, selling over 150,000 copies in its first few months. Clearly, it struck a chord with the British public.

Just over a decade later, on 5 July 1948, the NHS was founded. It did a huge amount for the medical profession’s reputation, though not initially. The BMA was one of the most vociferous opponents of the proposed NHS, not wanting medics to be relegated to the status of “salaried” workers. “The medical profession is,” declared the BMA, “opposed to any form of service which leads directly or indirectly to the profession as a whole becoming full-time salaried servants of the State.” Nye Bevan had to “stuff their mouths with gold” to get them on board: he allowed consultants to continue taking on private patients as well as NHS ones.

The mythical status of the NHS we recognise today didn’t emerge until later, in the early Seventies — in part due to the decade’s economic and political pressures, which prompted people to campaign in defence of the welfare state in ways they hadn’t felt they needed to before. The myth was also a product of subtle but deliberate NHS propaganda, in the form of TV hospital dramas, nurse recruitment films, and medical romance fiction.

As the health service grew in popularity, the public image of medics also slowly improved. But in 1978, their freshly-minted reputation was put to the test, when NHS doctors first went on strike over pay and working conditions. Indeed, some doctors were opposed to their colleagues taking industrial action, because they thought it compromised their high-minded principles. A consultant surgeon wrote in 1976: “Doctors have to decide whether medicine is to remain a profession with ethics or to become an industry with strictly regulated hours of work.” He criticised the strikes by arguing that the withdrawal of services would “make nonsense eventually of any idea of vocation”, which was “over and above job satisfaction”. That same year, another consultant wrote to the government to argue against industrial action, which had “immediately put the doctors on a par with the trade unions and other workers”. These ideas are still around. In 2016, the Telegraph argued against industrial action by junior doctors because their “vocation in life” is “to care”. Imagine saying the same thing of the striking civil servants.

Then again, it does make sense for healthcare professionals to think of themselves in these terms. Many medics really do feel a sense of devotion to their profession and to their patients. They do often take an oath. And if doctors couldn’t cling onto the idea of exceptionalism, would any of them stay in the job? During the height of the pandemic, doctors and nurses were working impossible hours, under extreme pressures, and the very real risk of serious illness or death loomed over them. One in ten health workers in England during the pandemic had suicidal thoughts. There is still a palpable crisis of wellbeing among NHS staff, pay has stagnated, and the number of doctors fleeing the UK in search of better jobs elsewhere has sky-rocketed. And Rishi Sunak’s plan to boost the workforce, announced on Friday, seems squeamish of acknowledging the true challenges to retention. Is it any wonder that doctors try to find meaning in a romantic ideal of their work, rather than just focusing on the day-to-day drudgery and dehumanisation that so often characterises employment in the NHS?

But politicians who characterise doctors as saints often do so to deny their right to industrial action. They don’t need better pay or working conditions, or so the argument goes, because their jobs are so meaningful. Members of the public who buy into the myth, even if they are well-meaning, obscure the bleak state of the NHS. During the pandemic, we clapped for health workers because there was little else we could offer them. You could text CLAP to 70507 to donate £5 to NHS charities, knowing that the service itself was inadequately funded. The public was unable to provide the NHS staff with the protective equipment they so desperately needed — but it could tell them they were heroes.

Doctors cannot live on saintliness alone. Poor pay and conditions means it is often hard for medics to stay professional — let alone heroic. How can you devote yourself to patients, or even show them compassion, when you can only speak to them for seven minutes at a time? In 2022, 51 million GP appointments lasted less than five minutes. 94% of NHS doctors surveyed said short appointment times put patients at risk and one in three GPs admitted they have failed to properly diagnose patients due to time constraints.

We also need to recognise that some doctors are bad at their jobs, no matter how much time and money they’re given — just as some teachers and civil servants are also no good. But the medical profession’s glowing reputation makes it hard to confront this fact. While doctors are frequently targets of abuse, sometimes they treat their patients poorly. Not all doctors are competent, and their vaunted position in today’s society can make it a lot harder for patients to have their complaints heard, for abuses to be taken seriously, and lasting improvements to be made. In 2013, the NHS Ombudsman found that patients were often “too frightened to complain” about problems with their care.

Doctors are just people. If we just thought of them not as heroes but simply as skilled professionals doing their jobs — sometimes well, sometimes not so well, sometimes in impossible circumstances — we could level out the power dynamic between them and patients, making it easier for the latter to get their voices heard. Doctors, too, would be better equipped to advocate for themselves. And the NHS as a whole might be forced to stop falling back on the myths of medicine’s heroism, stop relying on its workforce’s goodwill, and reckon with the radical reforms needed to make the service fit for purpose in its 75th year. Some doctors might be reluctant to let go of their romantic ideals. But surely a slight drop in social status is a price worth paying for a comfortable working life?


Agnes Arnold-Forster is a historian of healthcare and Chancellor’s Fellow at the University of Edinburgh.

agnesjuliet

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Milton Gibbon
Milton Gibbon
9 months ago

I agree that a lie is given to the term “calling” when even the consultants are on strike. As with most public sector jobs the starting salary is not reflective of the average salary and when you are on a path to anywhere near 100K a year it isn’t reasonable to be going on strike. Overtime is not only freely available but logged with military efficiency – unlike patient data.
To say that the risk of death “loomed over” doctors when such a tiny number actually died from (not with) Covid is hyperbolic. Before you look the figure up it would be best to bear in mind what you think it is. That they worked “impossible hours” is flat out wrong – no one could make them work an hour over their time if they didn’t want to – a far cry from the days of the family doctor.
There are things that I sympathise with the doctors on, hyperchondriacs taking up an inordinate amount of time, rude patients and poor equipment but if they don’t want these things then don’t work in the NHS. Plenty are moving away as the article states and I would encourage more to do so if that is what they want. Just don’t go on about how you want to serve the public when really what you want is a higher wage.
The statement of a “crisis of wellbeing amongst NHS staff” is an outrage. 1/10 having suicidal thoughts is excellent compared to the general population and when you take into account children as a sub-group this number is over half. A classic statistical manipulation on the part of the author.

j watson
JW
j watson
9 months ago
Reply to  Milton Gibbon

Early on when we knew much less about the virus, and had limited PPE, many doctors and nurses were pretty heroic. As staff went ‘down like flies’ either with Covid or just frightened, a core kept the show on the road and the ‘espirit de corps’ behind that should not be under-estimated.
I do agree some of the hagiography is unwarranted though. Doctors and nurses divide between knights and knaves much as rest of population does. The dilemma for public policy is how one designs recognition systems that cater for both psychologies.

Graham Cunningham
Graham Cunningham
9 months ago
Reply to  Milton Gibbon

And the article never mentions just how many GPs work part time…a majority in fact I believe. They do this presumably because they can afford to.

Jodie Willett
JW
Jodie Willett
9 months ago
Reply to  Milton Gibbon

Agreed. As the partner of a GP I am constantly reminding him that he is a business owner, and can charge a fair price for his time. While he acts like a state employee bound to help everyone and not charge more than the low government rebate for treating complex patients. Doctors wages are high because the population is overweight and old, and the number of doctors is throttled by both the government and the colleges who wish to retain higher earnings for their members. They earning multiples of the average wage working for the state, and as you point out, if this isn’t enough do what other employees do and leave for greener pastures.
The only thing which happens when you raise their income, is you get less doctor-hours, as they drop down to part time.

j watson
JW
j watson
9 months ago
Reply to  Milton Gibbon

Early on when we knew much less about the virus, and had limited PPE, many doctors and nurses were pretty heroic. As staff went ‘down like flies’ either with Covid or just frightened, a core kept the show on the road and the ‘espirit de corps’ behind that should not be under-estimated.
I do agree some of the hagiography is unwarranted though. Doctors and nurses divide between knights and knaves much as rest of population does. The dilemma for public policy is how one designs recognition systems that cater for both psychologies.

Graham Cunningham
Graham Cunningham
9 months ago
Reply to  Milton Gibbon

And the article never mentions just how many GPs work part time…a majority in fact I believe. They do this presumably because they can afford to.

Jodie Willett
JW
Jodie Willett
9 months ago
Reply to  Milton Gibbon

Agreed. As the partner of a GP I am constantly reminding him that he is a business owner, and can charge a fair price for his time. While he acts like a state employee bound to help everyone and not charge more than the low government rebate for treating complex patients. Doctors wages are high because the population is overweight and old, and the number of doctors is throttled by both the government and the colleges who wish to retain higher earnings for their members. They earning multiples of the average wage working for the state, and as you point out, if this isn’t enough do what other employees do and leave for greener pastures.
The only thing which happens when you raise their income, is you get less doctor-hours, as they drop down to part time.

Milton Gibbon
Milton Gibbon
9 months ago

I agree that a lie is given to the term “calling” when even the consultants are on strike. As with most public sector jobs the starting salary is not reflective of the average salary and when you are on a path to anywhere near 100K a year it isn’t reasonable to be going on strike. Overtime is not only freely available but logged with military efficiency – unlike patient data.
To say that the risk of death “loomed over” doctors when such a tiny number actually died from (not with) Covid is hyperbolic. Before you look the figure up it would be best to bear in mind what you think it is. That they worked “impossible hours” is flat out wrong – no one could make them work an hour over their time if they didn’t want to – a far cry from the days of the family doctor.
There are things that I sympathise with the doctors on, hyperchondriacs taking up an inordinate amount of time, rude patients and poor equipment but if they don’t want these things then don’t work in the NHS. Plenty are moving away as the article states and I would encourage more to do so if that is what they want. Just don’t go on about how you want to serve the public when really what you want is a higher wage.
The statement of a “crisis of wellbeing amongst NHS staff” is an outrage. 1/10 having suicidal thoughts is excellent compared to the general population and when you take into account children as a sub-group this number is over half. A classic statistical manipulation on the part of the author.

Stephen Walsh
SW
Stephen Walsh
9 months ago

These days, only doctors think doctors are saints. And throughout Covid, there can hardly have been a more hackneyed and inaccurate line than “the public was unable to provide the NHS staff with the protective equipment they so desperately needed”.

Billy Bob
Billy Bob
9 months ago
Reply to  Stephen Walsh

Why is it untrue? Change “public” to “the government” and I think it’s pretty spot on, many healthcare workers didn’t have anywhere near enough PPE.
I fully support the doctors striking. If the money isn’t enough to retain skilled staff then it has to increase, same as any other profession

Martin Bollis
Martin Bollis
9 months ago
Reply to  Billy Bob

What is the money? Genuine question. Despite the acres of print I don’t actually know what the starting salary is for a newly qualified doctor. What he could expect to earn after 5 years. What an average salary is.

If journalists just provided a paragraph of basic facts instead of rhetoric I’d be in better position to make a judgement.

Billy Bob
BB
Billy Bob
9 months ago
Reply to  Martin Bollis

Whether it’s £10k or £100k is largely irrelevant, if it’s not enough to retain the staff then either that needs to go up or working conditions need to improve

j watson
JW
j watson
9 months ago
Reply to  Billy Bob

It’s c£30k for a newly qualified junior doctor and c£90k for a Consultant. Obviously some get London Weighting (peanuts but something), and can do additional shifts as overtime. Pension and other terms and conditions are pretty good if one stays the course.
We need to recognise though the debt they start with and how medical students are often some of the most intelligent and highest performing students we have. Were they to go into other fields of work they likely excel and be paid more. Yet we need doctors.
They aren’t paid as well as US and Aus doctors and we are losing some to both, but a bit better than some euro countries. We did well from euro recruitment until Brexit made it more difficult.

AJ Mac
AM
AJ Mac
9 months ago
Reply to  j watson

Geez. Two-click “research” shows that a starting average for doctors here is about 168,000 pounds ($213K). They should come to the US where they can write opioid scripts for extra cash on the sly too. They’d have to live among Americans like me though.

j watson
j watson
9 months ago
Reply to  AJ Mac

Yep. One of the reasons why our NHS such good value for money. Furthermore much less ‘fee for service’ so less danger of over treatment to generate higher bills. Debate no doubt for another day.

j watson
j watson
9 months ago
Reply to  AJ Mac

Yep. One of the reasons why our NHS such good value for money. Furthermore much less ‘fee for service’ so less danger of over treatment to generate higher bills. Debate no doubt for another day.

Richard Baker
RB
Richard Baker
9 months ago
Reply to  j watson

Speaking as an NHS consultant, my concern about pay is not the absolute amount, but downward trajectory. In most walks of life, there is a correlation between pay and calibre. The only doctors we can attract to the NHS are those from poorer, worse healthcare systems than our own or those UK doctors who haven’t left yet. I can tell you, standards are dropping and when no top notch doctors are left in the NHS, this decline will be irreversible. Because reimbursement in the private sector has been dropping since the 1990s, this will become true for the private sector too. When the proverbial hits the fan at 3am, it makes all the difference if the doctor
you see has a high IQ, is well trained and has put the hours(years) in. These are exactly the people who are/will leave the NHS.

AJ Mac
AM
AJ Mac
9 months ago
Reply to  j watson

Geez. Two-click “research” shows that a starting average for doctors here is about 168,000 pounds ($213K). They should come to the US where they can write opioid scripts for extra cash on the sly too. They’d have to live among Americans like me though.

Richard Baker
RB
Richard Baker
9 months ago
Reply to  j watson

Speaking as an NHS consultant, my concern about pay is not the absolute amount, but downward trajectory. In most walks of life, there is a correlation between pay and calibre. The only doctors we can attract to the NHS are those from poorer, worse healthcare systems than our own or those UK doctors who haven’t left yet. I can tell you, standards are dropping and when no top notch doctors are left in the NHS, this decline will be irreversible. Because reimbursement in the private sector has been dropping since the 1990s, this will become true for the private sector too. When the proverbial hits the fan at 3am, it makes all the difference if the doctor
you see has a high IQ, is well trained and has put the hours(years) in. These are exactly the people who are/will leave the NHS.

j watson
JW
j watson
9 months ago
Reply to  Billy Bob

It’s c£30k for a newly qualified junior doctor and c£90k for a Consultant. Obviously some get London Weighting (peanuts but something), and can do additional shifts as overtime. Pension and other terms and conditions are pretty good if one stays the course.
We need to recognise though the debt they start with and how medical students are often some of the most intelligent and highest performing students we have. Were they to go into other fields of work they likely excel and be paid more. Yet we need doctors.
They aren’t paid as well as US and Aus doctors and we are losing some to both, but a bit better than some euro countries. We did well from euro recruitment until Brexit made it more difficult.

Billy Bob
BB
Billy Bob
9 months ago
Reply to  Martin Bollis

Whether it’s £10k or £100k is largely irrelevant, if it’s not enough to retain the staff then either that needs to go up or working conditions need to improve

Charles Stanhope
CS
Charles Stanhope
9 months ago
Reply to  Billy Bob

“The Department for Health & Social Care (DHSC) lost 75% of the £12 billion it spent on personal protective equipment (PPE) in the first year of the pandemic to inflated prices and kit that did not meet requirements – including fully £4 billion of PPE that will not be used in the NHS and needs to be disposed of.”*

‘PROTECT THE NHS’……………INDEED!

(* UK parliamentary Committee Report.)

Billy Bob
BB
Billy Bob
9 months ago

The whole world was chasing PPE at the start of the pandemic, do you expect the prices to have remained the same in a time of such high demand? That’s not how capitalism works I’m afraid

Charles Stanhope
CS
Charles Stanhope
9 months ago
Reply to  Billy Bob

From the moment I heard our wretched PM say “protect the NHS” I knew we were about to enter a period of public panic not seen since 1940. And so it has proved to be.

Thus, and through no fault of my own, I was offered the chance to make a modest investment in this PPE nonsense. As a result it has turned out to be the investment opportunity of a lifetime.

Charles Stanhope
CS
Charles Stanhope
9 months ago
Reply to  Billy Bob

From the moment I heard our wretched PM say “protect the NHS” I knew we were about to enter a period of public panic not seen since 1940. And so it has proved to be.

Thus, and through no fault of my own, I was offered the chance to make a modest investment in this PPE nonsense. As a result it has turned out to be the investment opportunity of a lifetime.

j watson
JW
j watson
9 months ago

DHSC isn’t the NHS CS. I think you recognise this but to some the distinction will be lost.
DHSC, and lots of Tory cronies, ran the procurement. Like ‘Test & Trace’ the Govt too easily then let them use the NHS brand despite serious concerns being voiced that they never fell under proper NHS governance.

Charles Stanhope
Charles Stanhope
9 months ago
Reply to  j watson

Too true I’m afraid, hence offering an ‘amateur’ investor such as myself an opportunity of a lifetime!*

(*Annoyingly rather late for me, it must be said.)

Charles Stanhope
Charles Stanhope
9 months ago
Reply to  j watson

Too true I’m afraid, hence offering an ‘amateur’ investor such as myself an opportunity of a lifetime!*

(*Annoyingly rather late for me, it must be said.)

Billy Bob
Billy Bob
9 months ago

The whole world was chasing PPE at the start of the pandemic, do you expect the prices to have remained the same in a time of such high demand? That’s not how capitalism works I’m afraid

j watson
JW
j watson
9 months ago

DHSC isn’t the NHS CS. I think you recognise this but to some the distinction will be lost.
DHSC, and lots of Tory cronies, ran the procurement. Like ‘Test & Trace’ the Govt too easily then let them use the NHS brand despite serious concerns being voiced that they never fell under proper NHS governance.

JR Stoker
JS
JR Stoker
9 months ago
Reply to  Billy Bob

You make comments just to tease, don’t you? But in this one you have a point. If staff leave in large numbers, pay them more. But not otherwise

Billy Bob
Billy Bob
9 months ago
Reply to  JR Stoker

I don’t think I do, I just don’t think I’m as tied to any particular ideology as most on here. To ensure the UK doesn’t have a shortage of medical professionals they need to do 3 things.
1. Train more doctors
2. Retain the ones they have
3. Import from abroad where necessary.
You can’t do the last two if the wages aren’t high enough for the working conditions

Billy Bob
BB
Billy Bob
9 months ago
Reply to  JR Stoker

I don’t think I do, I just don’t think I’m as tied to any particular ideology as most on here. To ensure the UK doesn’t have a shortage of medical professionals they need to do 3 things.
1. Train more doctors
2. Retain the ones they have
3. Import from abroad where necessary.
You can’t do the last two if the wages aren’t high enough for the working conditions

Martin Bollis
Martin Bollis
9 months ago
Reply to  Billy Bob

What is the money? Genuine question. Despite the acres of print I don’t actually know what the starting salary is for a newly qualified doctor. What he could expect to earn after 5 years. What an average salary is.

If journalists just provided a paragraph of basic facts instead of rhetoric I’d be in better position to make a judgement.

Charles Stanhope
CS
Charles Stanhope
9 months ago
Reply to  Billy Bob

“The Department for Health & Social Care (DHSC) lost 75% of the £12 billion it spent on personal protective equipment (PPE) in the first year of the pandemic to inflated prices and kit that did not meet requirements – including fully £4 billion of PPE that will not be used in the NHS and needs to be disposed of.”*

‘PROTECT THE NHS’……………INDEED!

(* UK parliamentary Committee Report.)

JR Stoker
JS
JR Stoker
9 months ago
Reply to  Billy Bob

You make comments just to tease, don’t you? But in this one you have a point. If staff leave in large numbers, pay them more. But not otherwise

Billy Bob
BB
Billy Bob
9 months ago
Reply to  Stephen Walsh

Why is it untrue? Change “public” to “the government” and I think it’s pretty spot on, many healthcare workers didn’t have anywhere near enough PPE.
I fully support the doctors striking. If the money isn’t enough to retain skilled staff then it has to increase, same as any other profession

Stephen Walsh
SW
Stephen Walsh
9 months ago

These days, only doctors think doctors are saints. And throughout Covid, there can hardly have been a more hackneyed and inaccurate line than “the public was unable to provide the NHS staff with the protective equipment they so desperately needed”.

Edward De Beukelaer
EB
Edward De Beukelaer
9 months ago

The biggest problem is that doctors and many other medical staff are not trained for the reality of the job: their training is making them ready to prescribe the drugs they are taught (indirectly) by the pharma industry, putting patients in diagnostic boxes which really work for only 30-40% of patients. Even though they want to care they are not taught how to do this effectively. The NHS is not a health service, it is an illness service responding principally to the needs of the health industry. https://www.bmj.com/company/newsroom/many-nhs-partnerships-with-drug-companies-are-out-of-public-sight/. https://publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf
….. last year during the personalised medicine congress in London in June, Rangan Shatterjee said that there were 2 big problems with medicine: 50% of what doctors are taught is either untrue or not helpful (and that we do not know which 50% this is) and that there are too many egos in medicine. This was received with a big applause by the 800 strong audience and the ex health ministers and ex NHS bosses sitting on the podium…
The best way to be able to work in the illness industry that is our health service, is to ignore patients unless they (or their illnesses) comply with the rules: it a survival technique. If one of my children would have chosen to go into medicine I would have seriously argued with them; unless you want to work in the technical aspect of medicine where patient contact is minimum.
Unless we make the principal job of medicine to make people healthy (fostering health), that treating an illness is not sufficient unless the outcome is an improved health state, that we start researching how to make the whole person better rather than juts treat the boxed in diagnosis, (treat patients in stead of illness) nothing will change..

Edward De Beukelaer
EB
Edward De Beukelaer
9 months ago

The biggest problem is that doctors and many other medical staff are not trained for the reality of the job: their training is making them ready to prescribe the drugs they are taught (indirectly) by the pharma industry, putting patients in diagnostic boxes which really work for only 30-40% of patients. Even though they want to care they are not taught how to do this effectively. The NHS is not a health service, it is an illness service responding principally to the needs of the health industry. https://www.bmj.com/company/newsroom/many-nhs-partnerships-with-drug-companies-are-out-of-public-sight/. https://publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf
….. last year during the personalised medicine congress in London in June, Rangan Shatterjee said that there were 2 big problems with medicine: 50% of what doctors are taught is either untrue or not helpful (and that we do not know which 50% this is) and that there are too many egos in medicine. This was received with a big applause by the 800 strong audience and the ex health ministers and ex NHS bosses sitting on the podium…
The best way to be able to work in the illness industry that is our health service, is to ignore patients unless they (or their illnesses) comply with the rules: it a survival technique. If one of my children would have chosen to go into medicine I would have seriously argued with them; unless you want to work in the technical aspect of medicine where patient contact is minimum.
Unless we make the principal job of medicine to make people healthy (fostering health), that treating an illness is not sufficient unless the outcome is an improved health state, that we start researching how to make the whole person better rather than juts treat the boxed in diagnosis, (treat patients in stead of illness) nothing will change..

Walter Marvell
WM
Walter Marvell
9 months ago

No one trusts the NHS anymore. It is hurting so many. The Excess Death bodycount from it converting into a Panicked National Covid Service cannot be masked and is a national scandal. Pity this death toll is not recorded daily on the BBC which so manipulated and warped popular hysteria out of its longstanding NHS-philia. The ‘heroic’ and ‘national religion’ myths are now a tired base lie. We were water boarded as a nation through lockdown to protect the REPUTATION of an unprepared chaotic NHS. We were imprisoned to protect IT. Yet It could not function in an epidemic for more than a few weeks because it had (doh!) got rid of hospital beds to meet some barmy efficiency targets. The Hard Left & NHS workers cling to this monolithic 1940s relic, but only ignorant dupes would put up rainbow posters now while the BMA, its super rich consultants and the equally gold-plate pensioned cold eyed (food bank my arse) young doctors happily cancel yet more grannys surgeries as they pant for more money. As with the nurses They have forever debased their professional status by inflicting this cruel second dose of misery on us…the inflation caused by the 2 year lockdown ‘protection’. Its serious now. We should be bashing pans in protest at them. We need to be free of the ‘NHS First’ opiate.

Walter Marvell
WM
Walter Marvell
9 months ago

No one trusts the NHS anymore. It is hurting so many. The Excess Death bodycount from it converting into a Panicked National Covid Service cannot be masked and is a national scandal. Pity this death toll is not recorded daily on the BBC which so manipulated and warped popular hysteria out of its longstanding NHS-philia. The ‘heroic’ and ‘national religion’ myths are now a tired base lie. We were water boarded as a nation through lockdown to protect the REPUTATION of an unprepared chaotic NHS. We were imprisoned to protect IT. Yet It could not function in an epidemic for more than a few weeks because it had (doh!) got rid of hospital beds to meet some barmy efficiency targets. The Hard Left & NHS workers cling to this monolithic 1940s relic, but only ignorant dupes would put up rainbow posters now while the BMA, its super rich consultants and the equally gold-plate pensioned cold eyed (food bank my arse) young doctors happily cancel yet more grannys surgeries as they pant for more money. As with the nurses They have forever debased their professional status by inflicting this cruel second dose of misery on us…the inflation caused by the 2 year lockdown ‘protection’. Its serious now. We should be bashing pans in protest at them. We need to be free of the ‘NHS First’ opiate.

Bruce Metzger
BM
Bruce Metzger
9 months ago

Since the Covid pandemic I have accepted it as fact that medical people, despite their intelligence and knowledge to heal, are the most gullible and senseless people on the planet. Those medical professionals that excel in their skill and craft frequently employ common sense in dealing with patients. Medical people are too quick to trust the medical system because they have their own job to do. I speak as a former patient who has needed their help.

Bruce Metzger
BM
Bruce Metzger
9 months ago

Since the Covid pandemic I have accepted it as fact that medical people, despite their intelligence and knowledge to heal, are the most gullible and senseless people on the planet. Those medical professionals that excel in their skill and craft frequently employ common sense in dealing with patients. Medical people are too quick to trust the medical system because they have their own job to do. I speak as a former patient who has needed their help.

Jeremy Eves
JE
Jeremy Eves
9 months ago

Someone I know well has just returned from 9 months as an A&E doctor in New Zealand. 4 years after graduation pay would be £50k for a 37 hour week compared to £35k for a 48 hours week. Commitment to family and friends means long term emigration is not an option. But the NHS treats its medical staff very poorly. Inflexible rotas and shift working is a dehumanising constraint. Amazing that few senior managers work nights and weekends but are paid more than senior doctors.
Do lawyers, bankers, accountants carry the risk and responsibility that doctors do? Your life in their hands! The pay differentials say what we think of doctors. Most will not be consultants until late 30’s having earned modestly and even paid for advanced training out of after tax salary. They have the most student debt.

I do not support strikes, but I fully sympathise with their discontent. The governments latest idea to shorten training won’t support quality! If mangers in the private sector produced such awful results with disaster outs staff retention they would be sacked. Not so the NHS and public sector manager!

Daniel Hurt
DH
Daniel Hurt
9 months ago
Reply to  Jeremy Eves

I’m a doctor, and these figures can’t possibly be correct. A doctor 4 years post qualification working in A&E in the UK for 48 hours per week is either earning in the region of around £60k per year (if in training) or £90k+ per year (if all done as a locum and taking 10 weeks off per year). That’s to say nothing of the extraordinary pension scheme in the UK, which in early career is equivalent to around 50% more pay.

Daniel Hurt
DH
Daniel Hurt
9 months ago
Reply to  Jeremy Eves

I’m a doctor, and these figures can’t possibly be correct. A doctor 4 years post qualification working in A&E in the UK for 48 hours per week is either earning in the region of around £60k per year (if in training) or £90k+ per year (if all done as a locum and taking 10 weeks off per year). That’s to say nothing of the extraordinary pension scheme in the UK, which in early career is equivalent to around 50% more pay.

Jeremy Eves
JE
Jeremy Eves
9 months ago

Someone I know well has just returned from 9 months as an A&E doctor in New Zealand. 4 years after graduation pay would be £50k for a 37 hour week compared to £35k for a 48 hours week. Commitment to family and friends means long term emigration is not an option. But the NHS treats its medical staff very poorly. Inflexible rotas and shift working is a dehumanising constraint. Amazing that few senior managers work nights and weekends but are paid more than senior doctors.
Do lawyers, bankers, accountants carry the risk and responsibility that doctors do? Your life in their hands! The pay differentials say what we think of doctors. Most will not be consultants until late 30’s having earned modestly and even paid for advanced training out of after tax salary. They have the most student debt.

I do not support strikes, but I fully sympathise with their discontent. The governments latest idea to shorten training won’t support quality! If mangers in the private sector produced such awful results with disaster outs staff retention they would be sacked. Not so the NHS and public sector manager!

Chris Milburn
Chris Milburn
9 months ago

A Canadian doc chiming in. We have all of the same problems as you Brits, without the meagre safety net of a private system to back it up (that is illegal under the Canada Healthcare Act).
Our system is broken. Through generations of being public employees, docs have been reduced to whining about needing more and more funding every year as the only “solution” to our failures. We are no longer agents, we are cogs in the healthcare machine – one that only “experts” and politicians are qualified to tinker with.
And at the same time we act like cogs, we want to be paid like gods. At 53, I’m in the “bridge” generation. Not a complete dinosaur, but not a millennial either. Unlike my teachers’ generation, I didn’t spend every 2nd weekend on call, get called in to deliver babies at 2AM a few times per week, or miss out on 95% of social opportunities. But I was paid pretty much the same as them. New grads take extended parental leaves, don’t work any weekends or nights, or take every 2nd week off of salaried jobs like hospitalist or palliative care. And they get paid the same as I did for busting my ass 6 days per week. The same amount of pay is going out for physician services, and the public is getting less physician services for their tax dollar. Monopolies do not provide good service, and healthcare in numerous western countries is a monopoly (or, as in the case of the USA, so disfigured by government control that it is moribund and dysfunctional).
Doctors proved once-and-for-all that we are far from “healthcare heroes” when COVID-19 hit. We did as little work as possible for as much money as possible. We pretended to work, but unlike in communist systems the government actually did pay us – handsomely.
https://pairodocs.substack.com/p/are-doctors-selfless-healthcare-heroes
I am a collapsatarian when it comes to government-run healthcare. In Canada at least, we have been on a downhill trajectory for 50 years. I don’t think that doing the same things, only more forcefully, will make things any better.

Last edited 9 months ago by Chris Milburn
James S.
JS
James S.
9 months ago
Reply to  Chris Milburn

Thank you for the Canadian perspective. As a doc in the USA, I have heard for years the advocates for a more centralized (government-run) healthcare system tout the NHS and Canadian systems as models to be emulated.
I have NO illusions that the system I work in here in the States is a bed of roses; far from it. Among the problems in the American system are the undue influence of Big Pharma and the amounts of money that get siphoned up by the health insurance company bureaucracies, to say nothing of hospital administrations (example: no one at the hospital I work at can tell me what a “VP for Environments of Care” is responsible for, or what they contribute to patient care). As you point out, the US system is NOT a free market, fee-for-service system, except around the edges (cosmetic surgery as an example). Government mandates, regulations, and government payers have a huge distorting influence. My medical group’s payer mix has gone from ~40% government to ~65+% government payers in 14 years, largely goosed by Obamacare.
As for the “Doctors and nurses are saints” trope: I’m old enough (60s) to believe that it’s good medical practice to not abandon your patients, and that when one works every day with sick people, there is a risk that you may get sick. I worked through COVID as an anesthesiologist, and my group tried to help our ER and ICU colleagues with airway management early on (Lord knows we weren’t doing any elective cases!). But the “Healthcare Heroes” mantra wears very thin, and becomes hypocritical when I see it thrown around by the hospital administrators and bureaucrats who use it as emotional blackmail to get us to continually work more for less, pleading “financial crisis” after they pocketed $ incentives to care for COVID patients and now are deluged with pent-up demand for care and much sicker patients after the pandemic. When I’m told that “management thinks you can open more ORs by just working into the night, and on more weekends,” I’m very inclined to tell management to come down and sub for all the staff they cut during the pandemic and have not replaced.
Like my Canadian colleague, I don’t think that insisting on doing the same thing with more vigor will make things better. “First, do no harm.”

James S.
JS
James S.
9 months ago
Reply to  Chris Milburn

Thank you for the Canadian perspective. As a doc in the USA, I have heard for years the advocates for a more centralized (government-run) healthcare system tout the NHS and Canadian systems as models to be emulated.
I have NO illusions that the system I work in here in the States is a bed of roses; far from it. Among the problems in the American system are the undue influence of Big Pharma and the amounts of money that get siphoned up by the health insurance company bureaucracies, to say nothing of hospital administrations (example: no one at the hospital I work at can tell me what a “VP for Environments of Care” is responsible for, or what they contribute to patient care). As you point out, the US system is NOT a free market, fee-for-service system, except around the edges (cosmetic surgery as an example). Government mandates, regulations, and government payers have a huge distorting influence. My medical group’s payer mix has gone from ~40% government to ~65+% government payers in 14 years, largely goosed by Obamacare.
As for the “Doctors and nurses are saints” trope: I’m old enough (60s) to believe that it’s good medical practice to not abandon your patients, and that when one works every day with sick people, there is a risk that you may get sick. I worked through COVID as an anesthesiologist, and my group tried to help our ER and ICU colleagues with airway management early on (Lord knows we weren’t doing any elective cases!). But the “Healthcare Heroes” mantra wears very thin, and becomes hypocritical when I see it thrown around by the hospital administrators and bureaucrats who use it as emotional blackmail to get us to continually work more for less, pleading “financial crisis” after they pocketed $ incentives to care for COVID patients and now are deluged with pent-up demand for care and much sicker patients after the pandemic. When I’m told that “management thinks you can open more ORs by just working into the night, and on more weekends,” I’m very inclined to tell management to come down and sub for all the staff they cut during the pandemic and have not replaced.
Like my Canadian colleague, I don’t think that insisting on doing the same thing with more vigor will make things better. “First, do no harm.”

Chris Milburn
CM
Chris Milburn
9 months ago

A Canadian doc chiming in. We have all of the same problems as you Brits, without the meagre safety net of a private system to back it up (that is illegal under the Canada Healthcare Act).
Our system is broken. Through generations of being public employees, docs have been reduced to whining about needing more and more funding every year as the only “solution” to our failures. We are no longer agents, we are cogs in the healthcare machine – one that only “experts” and politicians are qualified to tinker with.
And at the same time we act like cogs, we want to be paid like gods. At 53, I’m in the “bridge” generation. Not a complete dinosaur, but not a millennial either. Unlike my teachers’ generation, I didn’t spend every 2nd weekend on call, get called in to deliver babies at 2AM a few times per week, or miss out on 95% of social opportunities. But I was paid pretty much the same as them. New grads take extended parental leaves, don’t work any weekends or nights, or take every 2nd week off of salaried jobs like hospitalist or palliative care. And they get paid the same as I did for busting my ass 6 days per week. The same amount of pay is going out for physician services, and the public is getting less physician services for their tax dollar. Monopolies do not provide good service, and healthcare in numerous western countries is a monopoly (or, as in the case of the USA, so disfigured by government control that it is moribund and dysfunctional).
Doctors proved once-and-for-all that we are far from “healthcare heroes” when COVID-19 hit. We did as little work as possible for as much money as possible. We pretended to work, but unlike in communist systems the government actually did pay us – handsomely.
https://pairodocs.substack.com/p/are-doctors-selfless-healthcare-heroes
I am a collapsatarian when it comes to government-run healthcare. In Canada at least, we have been on a downhill trajectory for 50 years. I don’t think that doing the same things, only more forcefully, will make things any better.

Last edited 9 months ago by Chris Milburn
Janet G
JG
Janet G
9 months ago

Two quotes from this article stand out for me:
“the sacred ministration of religion itself ‘ and
“The myth was also a product of subtle but deliberate NHS propaganda, in the form of TV hospital dramasnurse recruitment films, and medical romance fiction.”
I recall the early 1960s in an Australian rural town. On Sundays a large proportion of the population attended church. At the Anglican church Sunday evensong saw a full congregation. Then, suddenly, the numbers at evensong dropped. What had happened to cause this? A tv station had programmed the American series Dr Kildare for Sunday evenings. The heroic surgeon was the new saviour.
We used to say we were “a Christian country”. No longer. Our religion is bodily health and fitness, hospitals serve as cathedrals, surgeons as priests and nurses as temple handmaidens.

Last edited 9 months ago by Janet G
Janet G
JG
Janet G
9 months ago

Two quotes from this article stand out for me:
“the sacred ministration of religion itself ‘ and
“The myth was also a product of subtle but deliberate NHS propaganda, in the form of TV hospital dramasnurse recruitment films, and medical romance fiction.”
I recall the early 1960s in an Australian rural town. On Sundays a large proportion of the population attended church. At the Anglican church Sunday evensong saw a full congregation. Then, suddenly, the numbers at evensong dropped. What had happened to cause this? A tv station had programmed the American series Dr Kildare for Sunday evenings. The heroic surgeon was the new saviour.
We used to say we were “a Christian country”. No longer. Our religion is bodily health and fitness, hospitals serve as cathedrals, surgeons as priests and nurses as temple handmaidens.

Last edited 9 months ago by Janet G
rigby.kevinp
rigby.kevinp
9 months ago

I’m a little worried about the quasi-religious manner in which we’re beginning to regard the NHS. I found the 75th anniversary service at Westminster Abbey somewhat weird.

Lindsay S
LS
Lindsay S
9 months ago

The NHS is the government’s way of promoting Private Healthcare.

j watson
JW
j watson
9 months ago
Reply to  Lindsay S

Certainly extending the waits for surgery have aided the private sector, who train not one doctor or nurse too.
Important for folks to also understand – the private sector avoids the most complex stuff, including emergency medical care. Wants to cherry-pick the simpler stuff. That’s fine and can supplement NHS capacity, but we should recognise the limits before we assume private sector will willingly step in. Get seriously sick in a private hospital and good chance you’ll also be transferred to the closest NHS acute hospital.

Last edited 9 months ago by j watson
j watson
JW
j watson
9 months ago
Reply to  Lindsay S

Certainly extending the waits for surgery have aided the private sector, who train not one doctor or nurse too.
Important for folks to also understand – the private sector avoids the most complex stuff, including emergency medical care. Wants to cherry-pick the simpler stuff. That’s fine and can supplement NHS capacity, but we should recognise the limits before we assume private sector will willingly step in. Get seriously sick in a private hospital and good chance you’ll also be transferred to the closest NHS acute hospital.

Last edited 9 months ago by j watson
Lindsay S
LS
Lindsay S
9 months ago

The NHS is the government’s way of promoting Private Healthcare.

Rachel Taylor
RT
Rachel Taylor
9 months ago

I’m afraid I find the logic of the article rather confusing. Yes, there is a conflict between the NHS staff aspiration to sainthood and their going on strike. Yes, there is a guardian narrative of saintly doctors, nurses and midwives. But the central conflict is that the staff institutions of the NHS fight hard to retain their monopoly while refusing to accept the consequences of it. The situation is no different from the striking car, coal or steel workers who destroyed their industries while striking for better pay.