Bytheway ...adoctor’s besttool? Commonsense

THE past three decades have seen a move from eminence

based medicine, when decisions were based on the opinion of prominent medical specialists, to evidence- based medicine — with a nod to the preferences of the patient.

This change was neatly expressed by renowned heart surgeon Tom Treasure in a recent radio interview.

In his words, ‘medicine has become protocolised’ — care and judgment about treatment is now determined by guidelines, rules and regulations that must be followed.

But how does this sit in the untidy world of human beings who dare to turn up with their medical problems?

The issues that used to be solved by common sense and experience are now forced into rigid boxes with inflexible approaches informed by the ‘evidence base’.

Take the case of the 13-yearold — whose story I heard from colleagues — who arrived in labour at the end of her pregnancy. That she was pregnant at this age is shocking. But this story also highlights the absurdity of our red-tape culture in medicine.

The decision was made to give her an epidural, and so the paediatric anaesthetist was called; sadly, he had no experience in administering an epidural to a woman in labour.

But the specialist obstetric anaesthetist had no licence to treat children. Fortunately, the impasse was solved by an old- fashioned and rarely employed technique: common sense — though the senior obstetric anaesthetist had to spend some time outside their usual imposed comfort zone, no doubt forced to give an explanation later at a disciplinary hearing.

All very depressing but no doubt readers will note that similar situations now exist in teaching, banking and many other areas. So, toughen up.