Responding to the crisis of care
BMJ 2023; 380 doi: https://doi.org/10.1136/bmj.p464 (Published 24 February 2023) Cite this as: BMJ 2023;380:p464
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Dear Editor
This excellent analysis of the hole which modern healthcare has dug for itself reminded me of Dr Robert Lustig's statement that "Treatment is not cure; it's not even treatment". Yet the idea persists that somewhere out there, there must be the right pill, and if only we throw enough money at it the problem will be solved and the waiting list reduced. It's easy to understand how this mechanistic view, driven by crisis, has turned medicine into a conveyor belt.
We have put our faith in science, and lost sight of the person who is the reason for our being there. There is no pill which replaces the touch of a hand, or the look of concern in the eye. There is no pill which discusses whether a patient has had enough of treatment and wants to be left alone to die. Sometimes roses are more useful, more important, than bread. Given the poor general health of so many people in the developed world, it may even be that roses end up being the cure.
In a career caring for older people at the natural end of a long life, I have resisted treatment for the sake of it, doing stuff just because we can, but the tide of treatmnt at all costs continues to advance. Politicians and doctors share this unfortunate characteristic: the urge to treat, to be seen to be doing something, anything. A fearsome combination when the two professions are working together, as during the poandemic. The counter is, "Don't just do something; stand there". In the end, this may be the more humane approach. It may be the best medicine.
Competing interests: No competing interests
Dear Editor
I thank Dr. Heath and Dr. Montori from the bottom of my heart for writing this essay. They have expressed the inexpressible about what gives my own work as a general practitioner meaning in the face of the industrialization of medicine and what keeps me going even in the face of the mounting forces of this industrialization. The crisis they so articuately and beautifully desribe is not unique to health care in the UK and the US. The same forces are at work here in Canada and, I suspect, in most high income countries.
Not all physicians may feel this way about such forces and how they are transforming our work. Many see it as progress and some are even involved in profiting from these forces.
One of the many touchstone essays for me throughout my career has been Gayle Stephens "Family Medicine as Counterculture" based on lecture he gave in the late 1970s. The cultural forces that have been shaping medicine and the larger society since Dr. Stephens gave that lecture are capilaist, market forces. Indeed, political philosopher Michael Sandel has persuasively argued that over the past four decades we have moved from a market economy to a market society and has catalogued the corrupting effect of this on public institutions and the common good.
Your essay is, to my mind, part of that proud counter-cultural tradition of general practice. I will be sharing this widely with colleagues, students, friends and family - anyone who values what I have valued about caring for people as a physician these past three decades.
Competing interests: No competing interests
Re: Responding to the crisis of care
Dear Editor
Human illness is biopsychosocial. Extensive training of health teams is essential to identify, alongside innovations and technological skills, the various social, cultural, behavioral, environmental and psychological factors of health infrastructure (reducing costs and saving lives) that circumscribe the complexity of human life and the illness of people.
Competing interests: No competing interests