Tick-box healthcare is squeezing out our trailblazing doctors
Fifty years ago this week, Dr Christiaan Barnard did something many in the medical profession doubted would be possible by performing the first heart transplant.
it seems incredible that a procedure that’s now carried out all around the world was once considered to be far too complex and risky to be done.
this operation, which made Barnard a worldwide celebrity, revolutionised transplant medicine and transformed the lives of thousands of patients across the globe who medicine would otherwise be unable to help.
Barnard did this by ignoring what his contemporaries said — and medicine is full of such examples: mavericks who dared to think differently.
i’m reminded of the story of stomach ulcers. in 1982, two Australian doctors published an academic paper arguing that stomach ulcers were often caused by the bacterium Helicobacter pylori.
this contradicted the received wisdom that stomach ulcers were the result of stress or spicy food and the paper was not well received by the medical community.
to prove their hypothesis correct, one of the doctors, Barry Marshall, drank the contents of a petri dish containing the bacterium. Soon afterwards he began to experience gastritis and the stomach pains that precede an ulcer.
the discovery that an infectious agent was responsible for this widespread problem revolutionised its treatment, with antibiotics now the mainstay. H. pylori and its role in the development of duodenal and gastric ulcers is now standard medical exam fodder.
the refusal of mavericks such as Marshall and Barnard to accept the limitations of medicine would now be at complete odds with the carefully regulated, controlled and monitored environment that doctors now operate in.
these men graduated at a time when doctors were still considered to be individuals, capable of individual thought.
they were expected to be innovative, to question, challenge and take the initiative — obviously, without also doing wrong.
this has been replaced by a cohort of doctors who are browbeaten and cowed by red tape, trained by a system that values tick-boxing over initiative. We have bred a generation of infantilised doctors wary of deviating from the narrow path they have been told to tread for fear of being sued or disciplined.
it’s not just that they’re afraid to try new things: i worry they’re so indoctrinated into the tick-box culture that the patient and what’s best for them is lost. the victim in this is care and compassion.
A dying man on the ward where i once worked wanted to go outside to feel the sun on his skin and breathe fresh air.
He was prevented from doing so because of ‘ health and safety’ concerns. Not just stupid, but thoughtlessly cruel. it’s often been noted older doctors are far more likely to have questions raised about their performance than younger colleagues. An analysis in 2013 found that doctors over the age of 55 are six times more likely to be referred to the National Clinical Assessment Service Agency (NCAS) for problems than those under 35. Some conclude this shows skills diminish over time. But it doesn’t mean older doctors are more incompetent, only that they’re more frequently referred to the NCAS. there are many possible reasons for this, including ageism: where the mistakes of younger clinicians are overlooked, those made by older doctors may be seen as evidence of infirmity and so are taken more seriously.
But i think part of the answer lies in the behaviour shown by Barnard and Marshall. Older doctors don’t accept the status quo, blindly focusing on targets and adhering to strict guidelines; they question and do things their own way because this is how they were trained.
it is precisely these qualities which make them good clinicians, but which are despised by NHS bureaucrats and makes these doctors more exposed to disciplinary procedures.
While younger doctors may have a diploma in communication skills, there’s something to be said for a doctor with years of experience, who was trained to think rather than just follow instructions.