Letters, calls and emails: The NHS should not be led by patients

Dear Editor

Facing Christmas, facing a new year, the future seems to be getting closer. One wonders about the future of medicine.

Once upon a time, in the distant past, there was a well-recognised person to whom the diseased came, because although it was understood he could not be always right, he still was able to guide.

He spent his whole life learning to ask the right few questions, and to listen to the words and to the body of their patients, learning and teaching. Medicine was an art, difficult to learn and even more so to practise without error.

Far in the future, there will be a clerk available 24/7 to triage any question from any worried person, who after answering 1,001 questions in well-established protocols, will point to a number of body fluid tests and imaging, which will give an exact diagnosis to the ailment as well as its treatment. Medicine will be an expensive but exact science, with mathematical probabilities for every possible query.

At present, in no man's land, between a well-known past and a very uncertain future, doctors struggle with technology, with the need to be exact, the need to avoid error.

More and more protocols are followed, there is less freedom of which pathway to follow and there are clear routes signposted for everybody to follow, and in consequence, as they are expensive routes, the human cost becomes of paramount importance.

The rationalisation is simple: since anybody can follow the protocol, there is no need for an expensive expert; the diagnosis can be made by anybody trained to understand the algorithms.

We have healthcare assistants, health visitors, midwives, nurses, nurse practitioners, matrons, associates, GPs, GPs with special interests, consultants, all with partial knowledge of the medical encyclopedia.

As we live longer and our wealth grows, the mind turns quickly to any little health issue that could affect our long-lasting trouble-free lives.

But in this turmoil, where no mistakes are tolerated, where many tests are done simply to be on the safe side, where nothing is left unanswered, the human factor must pay the bill.

New tests and medicines are expensive: the need to test and treat more comes at a cost. There is a need to economise, and the only possibility is by delegating from top earners to lower earners in the chain, and creating protocols to avoid missing important information that could lead to litigation.

The simple things are left to be done by less trained personnel while experienced doctors focus on complex situations.

Thus we enter a vicious cycle; the inexperienced eye relies on more tests to be certain the decision is made with confidence. Costs rise and there is a need to delegate even further down the chain to save on human cost. But the expense will not decrease because ever more tests and consultations will be required.

And if the mind is not trained with simple cases how is it going to find the complex solutions sometimes required? The experts are no longer experts, because they are so concentrated in specific situations.

Perhaps the future is not as black I have painted it; perhaps the day will come when the patient accepts there is no need for further investigations. But to achieve this, we should change direction now. We should not aim to be patient led, or rather, politics-consumer led.

Dr Pablo Millares Martin, Leeds.

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