Monday, 24 November 2014

Why Do Doctors 'Fail'? A British Perspective

Atul Gawande's first 2014 Reith Lecture is eagerly anticipated by many including myself. He is an excellent surgeon and author, as well as an eloquent speaker, and his views on why doctors fail are of enormous interest to all of us. Nevertheless I can't help but feel that a British answer to the same question might be rather different to his. 
In a short preview on the BBC Radio 4 website, he explains that there are three reasons why doctors fail. 1. Ignorance. 2. Ineptitude, the failure to apply our vast knowledge of disease and its treatment effectively. 3. Hubris, the failure of doctors to realise their limitations.
I have no idea what course his talk will take tomorrow (I will have the radio on at 9AM) but I hope he will take into account the following point.
In most societies, doctors 'fail' to deliver the best possible care to all their patients due to a lack of resources, constraints placed upon them by systems they work in, and political factors. In the US, resources are concentrated on the few who can afford excellent healthcare while a large percentage of uninsured are 'failed' by their healthcare system, government, and possibly doctors. In the UK we choose to distribute those limited resources more fairly, so that access to healthcare is universal and not determined by privilege.
Where we 'fail' to consistently deliver the best possible care to every single patient due to limited resources (and the data suggests the NHS is a doing an excellent job compared to other healthcare systems in the world), please do not mistake this for ineptitude.

The real challenge for doctors in the future will be how we deliver existing treatments to everyone in the world cost effectively. This is in fact an area in which the UK leads the world. A shining example of this is the way the NHS delivers 24/7 heart attack care to everyone at no cost to the patient (see here). A system which cannot allow this to happen is the real failure in medicine. 
Disclaimer: Dr Gawande was an undergraduate at Stanford and then a Rhodes Scholar at Oxford. I was an undergraduate at Oxford and then a Fulbright Scholar at Stanford. Dr Gawande was named by Time magazine as one of the world's most influential thinkers. I was not.