Heroes Not Zombies

I took these photos one February a few years ago while visiting Bormes-les-Mimosa in the south of France. How many towns do you know which include a plant in their name? I’ve taken a number of photos of the mimosa blossoms there at this time of year. But I’ve visited this town at various other times of year as well. I love the colours used on the walls of the houses and the pastel shades used to paint their shutters. But perhaps one of the things I like best about this town are the citrus trees everywhere. Aren’t they beautiful?

One of the interesting characteristics of the citrus family is that many of them produce fruit several times a year, so there isn’t a single season to see the trees laden with all the fruit. So when I visit a town like this I’m struck by a certain consistency and continuity.

Consistency and continuity.

I’ve often been told those are two of my strongest characteristics. Despite the fact that I have ups and downs, good days and bad ones, and that I experience every day as different and every person as unique.

I read an article by Dr Clare Gerada today in the Guardian. She’s a GP and at one time was President of the Royal College of GPs. In her article she was reflecting on the changes in General Practice over the last 30 years, and reflecting with sadness over what had been lost. Her main point was that continuity of care had gone almost completely and that with that caring personal relationships built up over many years.

That’s an observation I’ve heard others make. It’s the experience my elderly relatives have had and it’s the experience I had during my dad’s final illness.

She said continuity had been sacrificed in a drive towards “efficiency” and I think that’s the hub of the issue. I’ve read a number of terms to describe the current system – “evidence based care”, “efficient care”, but also, “protocol, guideline and target driven care”.

Also, “industrialised” and “taxi rank” Medicine. These two latter terms capture key features. The health care system has been transformed by applying the practices used in industry where tasks and procedures take precedence over human beings, and where cost managent and/or profit becomes the goal. Where quantities, what can be measured, is given priority over qualities and experience. Taxi rank medicine is where you receive care from whichever doctor happens to come along next. Whether or not you’ve ever seen that doctor before, or will do ever again, is considered irrelevant.

If there is one single change I’d like to see in health care it would be to prioritise continuity of care. The more continuity there is, the more personal the care can be, the more relationship based, the more “joined up” and “holistic”. The more human.

Continuity of care requires putting human beings at the centre of Medicine. It matters who this patient is, who this doctor is, who this nurse or therapist is. We are human and each of us is unique.

We are not interchangeable machines.

Is it really a revolutionary thought to say that people matter more than procedures, profits or data in Medicine? (By the way I’m not saying data doesn’t matter, it’s just that, like fire, it makes a better servant than a master)