I wish to tell a story about the NHS and the role of doctors. In my last article (
16 August 2023), I drew attention to the loss of professionalism of some young members of the medical profession in England, as evidenced by their willingness to go on strike and thereby act positively to harm patients. Last week this worsened when some young consultants took the same action in that country, despite earning salaries that few others could even dream of.
These strikes, urged on by the so-called doctors' union, the BMA, have brought the profession into disrepute and, no matter the genuine concerns we all have about the state of the NHS, are disgraceful and make things worse. Beside the effects of doctors' strikes on the time spent waiting for medical attention, there is also the effect on schoolchildren considering becoming doctors, at a time when we clearly need more committed young people to enter the profession. I have recently spoken to two members of my own family considering this career who told me of their uncertainties.
There is only one good reason to wish to become a doctor: the desire to live a useful life helping other people. Many are drawn to this career by an experience of illness themselves or in a close relative, others by admiration of a family doctor or relative in the profession, some simply by the desire to do good. This desire to help the sick is essential, and if you do not have it, you should not consider medicine, no matter how good you are at chemistry, maths and physics.
By definition, the life of a doctor is stressful as it will involve daily contact with the ill and unfortunate, but the satisfaction comes from something few other professions offer: the gratitude of those helped. And the fact, sometimes ignored by the misfits, is that it offers financial security, a growing income, and a decent pension on retiring.
The young doctors on qualifying (and very few indeed who obtain a place in medical school fail to do so) are expected to continue training for a decade or more before acquiring sufficient expertise in their chosen role to take full responsibility for patient care. This period is an apprenticeship, at the end of which the young person will be expected to know a great deal about their chosen specialty and to be able to carry out the, often difficult, procedures required of a consultant.
As medical and surgical care advance, so this training becomes more taxing and nowadays trainees are afforded time off to study, but even in my time over 60 years ago, as a physician I learned such techniques as intestinal and liver biopsy, peritoneal dialysis, cardiac catheterisation and insertion of heart pacemakers. This was as nothing compared to my colleagues bent on a surgical career. Postgraduate examinations are part and parcel of this period of training and, as potential patients, readers will understand the need for this.
Now for my story. In 1971, I arrived in Cardiff as a new chest consultant. Until then, the main role of my predecessors had involved tuberculosis but thanks to remarkable advances in treatment that disease was rapidly coming under control, and our most troubling patients proved to be those with asthma, especially those who had severe, life-threatening attacks, a growing problem. While the primary role of a consultant is to treat patients, there is another, less obvious role – to find better ways of preventing and treating their conditions. This remains for me the most exciting opportunity for doctors, to improve the general practice of medicine in their specialty of interest.
With my successive trainees over eight years in Cardiff, we studied why asthma patients had died in the recent past and planned controlled studies of how best to treat the condition. We persuaded our colleagues to agree that all acutely ill asthmatic patients be referred directly to us, rather than haphazardly as had previously been the pattern of admission, and eventually arrived at a standardised and effective way of treating severe attacks.
We picked up from colleagues in Edinburgh a system whereby our patients could gain access to us directly on the phone if they needed to be seen urgently. This work involved our junior doctors being willing to come in at all hours to see our patients as we consultants did, but we never had problems and their reward came from their many publications in the medical journals and the boost to their future careers. Later, the standards we set became incorporated into national guidelines on asthma management.
My eight years in Cardiff were very busy but very satisfying for all involved – we worked as a team in the NHS for the benefit of our patients, but for me other challenges arose and I left for Scotland.
Now, a lifetime later, I have been reminded of those exciting and professionally profitable years on a short holiday in Wales for a celebration of my birthday with members of my family. While down there we visited old friends in Cardiff and were concerned to hear that one of their grandchildren had just been admitted to hospital with severe asthma. When we arrived we asked how she was and her mother told us how well she had been treated. Her description of her daughter's experience (and of hers as a mother) matched exactly what we had found to be the best way 50 years before – she even had a phone number to ring if she was worried about her daughter's progress after discharge. It brought tears to my eyes to hear that the work and extra effort our team had put in all those years ago was still benefitting patients.
It may be argued that what we did would not be possible now with all the administrative red tape in the NHS, and there is some truth in that. But red tape is there to be cut (we certainly cut some) and during Covid-19 it was cut in a big way to good effect by determined doctors in pursuing trials of drug therapy and setting up new ways of managing the huge numbers of seriously ill patients.
The force for change, for better management of disease in the NHS comes from the commitment and professionalism of doctors and nurses, backed by many other caring professionals, who are prepared to do that little extra for the sake of their patients. It will not come from malcontents whose concern is primarily their salary and who apparently thought medicine would be an easy option. This extra effort is not accounted for by those who see the role of the NHS purely in terms of patient throughput and value for money. You cannot purchase professionalism.
So long as medicine and nursing recruit the right people, those who feel a vocation, the NHS will be in safe hands. My tale is that of many thousands of professionals who work in the NHS, who very reasonably complain about the conditions that prevent them giving their best, yet still strive to ensure that the NHS continues to serve the population well in their own little part of it. My experience now as a patient is that the NHS still works but, as it did 60 years ago, it certainly needs improving and if governments let them, those good doctors and nurses will improve it.
Anthony Seaton is Emeritus Professor of Environmental and Occupational Medicine at Aberdeen University and Senior Consultant to the Edinburgh Institute of Occupational Medicine. The views expressed are his own
