In the face of rising demand, changing technology and different relations with the public, BMA president Pali Hungin has decided that it’s time to bring together medical experts to decide how to thrive in a radical, new era of medicine. Tim Tonkin reports
In a passage from his 2002 book Complications: A Surgeon’s Notes on an Imperfect Science, US physician and public health researcher Atul Gawande ponders a dichotomy faced by people who practise medicine.
‘We look for medicine to be an orderly field of knowledge and procedure,’ he writes. ‘But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line.’
Uncertainty and inescapable change form the twin impetus for BMA president Pali Hungin, who is seeking to start a dialogue about the global future of doctors and medicine in a fast-changing world.
From financial limitations, rising demand and the impact of technology on the delivery of treatment and the doctor-patient relationship, Professor Hungin believes that medicine worldwide faces challenges destined to reshape the role of doctors and healthcare.
To this end, the BMA will host a series of round-table discussions on this subject, with a range of experts from across medical fields, culminating in a meeting in late April drawing on perspectives from other countries.
‘The reason I am driven about this project is that I believe we have something precious that’s worth saving,’ Professor Hungin explains. ‘We are entrusted with people’s lives and, in the UK, are considered as having good judgement, coupled with a long tradition of patient-centered medicine.
‘Patients remain central to our profession,’ he added, ‘but the relationship with the public has altered.’
From his perspective, the challenges facing this long-standing tradition are all too evident. As patient demand for doctors grows in the UK, there are worrying signs that the retention of doctors is heading in the opposite direction.
According to the Foundation Programme’s 2016 career-destination report, 58 per cent of foundation year one doctors said they planned to progress immediately to specialty training, down from 66 per cent in 2014 and 61 per cent in 2015.
Added to this, a substantial proportion of those working on the front lines are opting for early retirement while others continue to contend with stress-related problems owing to staffing deficiencies and under-resourcing.
These place severe limitations on time spent with patients and being able to meet their needs.
Understandably, many of the doctors who face these realities on a daily basis, feel the pressure resulting in issues such as low morale, burnout, depression and alcohol and substance misuse.
Indeed, a 2016 study by Cardiff University of almost 2,000 UK-based doctors found that 60 per cent had experienced issues with mental health, a figure that rose to 82 per cent among doctors in England.
‘Many doctors are choosing to leave their careers early because they are not managing to do their jobs in a way that provides them with satisfaction. The joy of being a doctor is a diminishing commodity not only in the UK but globally,’ Professor Hungin explains.
‘Allied to that is the fact that there is not enough time with our patients. Continuity, which is an important factor for patients, is another factor that’s becoming more difficult [for doctors to provide]. This is despite the fact that continuity is good for patients and for the healthcare system.
‘A doctor’s life is much more difficult if you’re under stressful pressure and you have no sense of continuity with the patient.’
While scientific advances have improved treatment outcomes in incidents such as heart attack or stroke, what often proves more difficult, owing to continuing deficiencies in community-based and social care, is the provision of follow-up care once a patient is discharged.
At a time when patients are increasingly medically aware, the gap between what treatment options might exist and what can realistically be provided, can be an immensely frustrating experience for doctors.
Professor Hungin explains these pressures are being heightened by the stark contrast between the idealised form of medicine taught to doctors while in training, compared to the reality of what can be provided in a surgery setting.
‘If your patient has had a stroke and they are transferred home very quickly after appropriate treatment, you feel you are letting them down because you cannot get adequate amounts of physiotherapy or occupational therapy organised for them.
‘As a GP, you get caught in the middle between the expectations of the family and the patient, and your inability to organise further management for them.
‘There is the obvious discrepancy between a medical student being told that the patient should be the centre of their vocation and professional aspirations, and realising, not only do you not have enough time for them, but what you feel you need to do for them [patients] isn’t necessarily easily available.
‘When you’re taught that kind of excellent, perfect medicine and you feel you’re not able to practise it the discrepancy is very costly.’
The abundance of medical information resources now available on the internet has had a profound effect on the doctor-patient relationship.
While patients are often now better informed and placed to describe their health concerns to their doctors, this increase in awareness has also led to a greater sense of expectation and entitlement.
According to Professor Hungin the evolving nature of their professional relationship is further complicated by patients’ extended needs and wider societal changes.
‘Consultation rates in all countries around the world have risen,’ Professor Hungin explains. ‘[At the same time] the relationship between the patient and doctor is evolving.’
Medicine, and the doctors who practise it, could well be on the verge of entering a new era.
From the rise of new innovations such as personalised medicine and artificial intelligence to cultural shifts and increasingly ageing populations in a potentially post-antibiotic age, adapting to the new landscape could prove radical.
The immediate task that falls to clinicians and health leaders is to attempt to determine the likely hallmarks of this new era and how medicine will need to adapt.
Establishing solutions to the challenges will be a continual process, and the BMA is far from alone in exploring these issues.
The Royal College of Physicians is staging a year-long investigation into medical professionalism and trust due to completed in September, working with the GMC and the medical royal colleges.
Three discussions have already taken place, with another planned for 7 March, to be followed up by an international meeting on 21 April.
The aim will be to produce a report outlining the themes, areas and ideas discussed at the conference, which will be published ahead of this year’s annual representative meeting.
Professor Hungin is under no illusions as to magnitude of the challenge facing his profession, but said that doctors of today had a responsibility, to themselves, and to those clinicians of future years following in their footsteps.
‘As a profession we need to look at how society, technology and our relationship with patients may be different in the future and start to think about how our role as professionals may need to change.’
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