Chris Lancelot: The virtually perfect Department of Health

The DoH has cancelled its seasonal campaign reminding patients that 'antibiotics won't help your cold' because it has finally dawned on them that the public does not fully understand the difference between antibiotics and antivirals - something of a problem in a flu pandemic.

While there are downsides to its decision, I am sure it is the right one. What is more, it heralds the possibility that the DoH might actually be getting in touch with real life. For too long the DoH has lived in a virtual reality NHS where all works smoothly, and everything has its place (and its tick-box). In the virtual reality NHS things are always crystal clear. Patients are never over-demanding; they always ask for the right things at the right times, are content with the answers, and always follow advice.

As a result, appointment slots are always available. Staff are never overloaded, and so have lots of time for extra meetings, surveys and training. Doctors make accurate diagnoses immediately, and seldom need to refer; MRI scans are instantly available; and treatment is given according to protocols which always work. Finally the patient is healed (tick the box).

Being a manager in this virtual NHS must be a cosy experience, surrounded by confidence and certainty at every step.

The real world is very different.

Diagnosis can be difficult and uncertain, especially at first presentation. Patients can make excessive demands, but even so may not take the medication, nor heed the advice. Diseases do not always respond to first-line drugs. Resources, people and time are at a premium.

In short, real-world medicine is difficult, under-resourced, overstretched and fuzzy at the edges. It does not fit into neat boxes, it is complex, and there are seldom easy answers.

Unfortunately, because their virtual reality seems so efficient, if the real NHS is not functioning, DoH and PCT managers are likely to assume that healthcare workers are messing up their precious plans through incompetence or laziness. In their eyes, there is no other possible explanation.

But now there is hope: abandoning the 'don't demand antibiotics' campaign means some real-world thinking is creeping into DoH decision making. I hope it lasts.

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