Society
I'm a doctor, and I'm scared
Published 01 March 2004
Observations on health service
Britain's relentless drive towards medical sub-mediocrity continues. An editorial in the British Medical Journal has drawn attention to the ever-poorer training of surgeons in this country. A recent poll of consultant surgeons found that two-thirds would not want to be operated on by surgeons who had undergone the training that they themselves now supervise. As for the public - let's just hope they never find out.
Before 1993, consultant surgeons had 30,000 hours of training before appointment. Now they have 8,000 hours, and with the introduction of the European Working Time Directive, this will probably fall to 6,000. This change has not been brought about by any improvements in methods of teaching, or any change in the technical requirements of surgery; it has been brought about by purely extraneous political pressure. Inadequately trained surgeons are a direct consequence of a loss of the medical profession's independence.
The picture painted in the BMJ editorial is alarming. Surgeons halfway through their training lack the most basic surgical skills; moreover, in the current climate of target fetishism, there is every incentive for consultant surgeons to reduce the time and attention they devote to teaching the generation below them. For example, it takes less experienced surgeons much longer to perform operations than the consultants, but the consultant is judged by the time taken to perform all operations under his direction. He therefore gives his junior staff less opportunity to operate under his supervision: it is quicker and better to do everything himself.
Part of the problem is that reform is seen always as being good. So, once it has taken place, it is irreversible. For to reverse it is to return to the unreformed era, which was by definition in need of reform. The more reforms we have, therefore, the better things get. But as the editorial points out, successive waves of reform have led to a situation where, for example, a third of senior house officers in orthopaedics receive no training either in the operating theatre or in the clinics, but are simply holding the fort back in the wards.
For the first time, I would now be afraid, for purely medical reasons, to be admitted to the hospital in which I practise. Few people realise how much pure repetition and practice are necessary in the making of good doctors and surgeons, except perhaps for those few doctors and surgeons who are natural geniuses. A doctor of ordinary gifts but who has seen 50,000 cases is almost certainly a better bet than a man of superior gifts who has seen only a few hundred.
To appoint inadequately experienced doctors to the positions of highest responsibility is asking for trouble. A survey in the north-west of England found that half of all currently suspended consultant surgeons had been in post fewer than two years, suggesting that this trouble has already begun.
The British had better get used to the idea of second-rate medicine. It is the future.
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