There’s a terrible tendency these days to reduce the practice of Medicine to a slavish following of protocols and guidelines. In society there is a strong drive to uniformity and conformity – but that drive doesn’t come from individuals. It comes from the machine-like models of corporations and corporate management methods.
Iain McGilchrist says, in The Divided Brain,
We kid ourselves that doctors, teachers, policemen are there to develop a ‘product’ which we can then ‘get’ or consume. But this is nonsense. We don’t know beforehand what it is we are to go after and ‘get’, because it varies in every single case, and is dependent on a relationship between individuals.
Yet it seems we are increasingly pushed to demonstrate “outcomes” which are set before we begin, and are measured (presumably) after we have “finished.”
I think the prime job of a doctor is diagnosis – in the old sense of the word – an understanding. In other words a doctor’s job is to understand. To understand a person and to understand what they are experiencing, whatever artificial label of a named disease we apply.
Understanding is never complete.
So, diagnosis is never finished.
The GMC, in “Tomorrow’s Doctors”, says that a doctor’s job is to be able to handle complex situations and to deal with uncertainty. We need a bit more of that. We need to shift the focus away from tasks, outcomes and targets, all of which imply products and endpoints, to human beings. Every single human being is unique, and nobody, but nobody, can accurately predict how the future is going to unfold for an individual.
Medicine is a relationship between two people. One acting in the service of another. It can’t be reduced to measurable tasks. And it certainly can’t be reduced to the act of writing a prescription!