Weeknote 77 – on healthcare

This week’s weeknote takes a slightly different form as I write it from an isolation room in the children’s ward at Kingston Hospital. Our youngest son Milo is asleep on my chest as he gets over a bout of bronchiolitus, a viral infection of the narrow airways of the lungs. He’s on the mend, but I don’t think there can be much more heartrending a sight than your own child hooked up to an oxygen unit.

I seem to have spent quite a bit of time in the last few years in. hospital, some of it joyous (the births of our two children) and some of it just stressful (two close family members going through cancer treatment). Throughout it all I have come to a couple of conclusions: that the healthcare system is broken in many fundamental ways; and that the NHS, providing care free at time of need at at the point of delivery, is the single thing that makes me most proud to be from this country and is the single biggest legacy that resulted from the tremendous sacrifices made by my grandparents’ generation.

The things that I think are broken about healthcare are not things that would be fixed through economic liberalism and privatisation. They are cultural within the nature of healthcare professionals and of our expectations of science and medicine.

First of all, healthcare its run by a triumvirate of healthcare professions (the doctors, the nurses and the administrative managers) with myriad hierarchical subdivision, who seen unable to communicate across professional divides with consistent effectiveness. They each have different motivations and objectives within the system, and appear to have trust issues with each other.

Secondly, we the patients expect that everyone in the healthcare world is there to “care”. However, if instead of thinking of doctors (in particular) as members of a “caring profession”, and instead one thinks of them as biology geeks with all of the common social things that go along with geekery, then you can manage expectations about how you will be communicated with during the delivery of medical science.

Finally, we also like to think that medicine gives objective, binary diagnoses and outcomes. Of course, though, it’s not theoretical physics and so therefore open to subjective interpretation throughout.

To improve healthcare we need to both help the professions work together more effectively and also manage our own expectations about what can be provided.

There’s an old friend of mine who is a vet. In the years he’s been practising, there has been an explosion in pet health insurance. It’s meant that he is now able to do more and more elaborate surgery because ultimately there is more and more money in the system. Insuring for health for dogs and cats hasn’t made the system any more efficient. Then compare per capita healthcare costs in the US (for example) with the UK…

I am incredibly grateful that we have ths NHS system in place, and to all the people who have been involved in the care of people I love in the past few years. Improvement is absolutely necessary… but I, for one, don’t think it its a simplistic matter of changing the economic foundations of how we find and provide healthcare in the UK.

Next week: hopefully back to some sort of normal.