Doctors are humanitarians. By definition.

It may surprise you to know that most qualifying doctors in the UK never takes the ‘Hippocratic Oath’. Although it’s principles underlie much of the modern medical practice, it’s a little outdated. For example, we don’t ‘teach medicine to only the sons of doctors’ anymore and no others (e.g. no women).* Which is not to say ethics is ignored in the UK medical curriculum- in fact very much the opposite. I would say ethics and law formed perhaps as much as 15% of the undergraduate course at my medical school and at least 20% of the clinical side, not to mention underpinning every patient discussion and clinical decision besides.

The overriding principles of medical ethics are fourfold; 1) Autonomy 2) Beneficience (Do the best for your patient) 3) Non-maleficience (Do no harm) and 4) Justice (treat all patients fairly). I have been watching very closely events in Gaza over the past week, on social media as well as mainstream news, and given the above, am appalled at some of the attitudes my colleagues have.

First off, to date, over 150 civilians have died, with as much as a third of that number children. If you are asking “Children from where?” – then ask yourself “Are you a human being?” And then stop reading this blog because I have no time for you.

They are children. There is nothing in international law, the Geneva convention, the Bible or Torah or Qu’ran, or basic, human morality that justifies the murder of children in the name of ‘defence’. **

I have seen on social media colleagues who lambast ‘liberal’ critics of Israel saying they ‘do not know what it is like to live under existential threat’. Let me be very clear, there is nothing ‘liberal’ or ‘conservative’ about the views on the death of children by military attack. To use those terms implies a nuanced political argument about the death toll; ‘liberals’ would like less children to die, ‘conservatives’ are more pragmatic and accept a higher toll. In the 21st century to sit and debate whether civilian casualties are deemed ‘acceptable’ is abhorrent and appalling.

Maybe I don’t understand the unilateral support for any state regardless of it’s actions. I grew up in Britain, a country renowned for it’s continuous dismay and critique of it’s own government, in a countryside town as the only brown face in a sea of white. The only sense of tribalism I have ever encountered is as a doctor- the ‘tribe’ of the MBBS has it’s own vernacular, it’s own set of values, it’s own unique perspective on humanity and it’s own rigorous ethical code. Which is why I cannot understand doctors who put out statements in support of any military action, but especially those that have had such high civilian death tolls. The value of life to a doctor is his or her entire meaning – if they didn’t want to preserve and defend life from illness and suffering they wouldn’t have signed up. But we have a duty to apply those same principles to every part of our life. We must not only ‘do no harm’ to the patient in front of us, but be champions of that humanitarianism across the board- on social media, to our friends, to our families, to our Governments.

Evil only persists in this world when good people do nothing. I cannot imagine a stereotype closer to ‘good people’ than a doctor. Colleagues, please, live up to it.

 

Juniordoctorblog.wordpress.com

 

*(in fact the majority of junior doctors and medical students now are women).

** The international law surrounding self-defense against occupied territory is very complex and makes for an interesting read if you feel like reading something important. See below;
http://www.cjpmo.org/DisplayDocument.aspx?DocumentID=71
and; http://opil.ouplaw.com/view/10.1093/law:epil/9780199231690/law-9780199231690-e401?rskey=xMiUjV&result=271&q=&prd=EPIL

 

 

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Happy Birthday: The National Health Service

You might not know this, but it is the NHS’s birthday today. It will be the tender age of 66-years young, born on the 5th July 1948. For those of you thinking of cracking jokes about ‘retirement’ age, please don’t. At the time, The Guardian hailed it’s creation “not as an achievement, but an opportunity”[1]. I wonder what they might have meant by that, and what they might make of the NHS today? Reading through the comments from last week found some old myths about the NHS resurfacing. I thought it might be worth looking a bit closer at a few of the common ones, with a bit closer eye than the standard Daily Mail monocle.

Myth #1

The NHS is already too expensive

Here is how much the UK spends on healthcare (both private and public expenditure): 9.4% of it’s GDP annually in 2012. Which is equivalent to $3647 or £2126 (at the time of writing) per person per year, or £177/ month. 82.5% of that is public money, i.e the NHS.

http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?order=wbapi_data_value_2012+wbapi_data_value+wbapi_data_value-last&sort=desc

Here is how much the US spends on healthcare: 17.9% of it’s GDP annually in 2012. Which is equivalent to $8895 or £5195 per person per year, or £432/month. 2.44 times as much as we do. 46.2% of that is public money, and 53.8% is paid through private insurance companies or directly out-of-pocket.

In fact, in 2012, the UK was ranked 29th on the list of countries spending their % GDP on healthcare, a list that has not only Canada, New Zealand and the US ahead of us, but also the Marshall Islands, Serbia and Moldova.

The bottom line: We don’t spend very much on healthcare compared to the rest of the world.

Myth #2

The NHS is rubbish

As above, 82.5% of all money spent of healthcare in the UK is public, mostly NHS money. It’s very hard to extract how good a job any healthcare system does, especially between countries where the populations and local factors are so varied. But here are the stats.

These are the all-cause mortality figures for the UK from 2012/3;

Maternal mortality ratio: 8 deaths per 100,000 live births (Joint 8th in the world)
Mortality rate per infant 4 deaths per 1,000 births (Joint 4th in the world)

Life-expectancy at birth: 82 (Joint 2nd in the world)

These are the same figures from the US from 2012/3;

US:
Maternal mortality ratio: 28 deaths per 100,000 live births
Mortality rate per infant: 6 deaths per 1,000 births
Life-expectancy at birth: 79

Bottom line: The vast majority of healthcare in this country is NHS-led and, despite spending less than half as much as our American cousins, has much better outcomes for pregnant women and marginally better outcomes for children and a longer life expectancy, by three whole years.

http://data.worldbank.org/indicator/SP.DYN.LE00.IN/countries

Myth #3

Private care is better than NHS care

I looked very hard for some proper, rigorous, scientific trial looking at this but it isn’t out there as far as I can see. But, as pointed out above, in a country (the US) where 54% of the healthcare is private, health outcomes are poorer than in a country where 85% of the healthcare is publicly provided.

If you take the amount above as everyone paying for his equally- your NHS care costs £177/month. For that, you are covered for nearly any serious health condition, unlimited GP attendances, hospital stays, surgeries, imaging, lab tests- the lot. That’s not to say there are few things not covered by the NHS- but you’d be hard pressed to find them on private health plans. In fact, hunting around on private healthcare websites, I struggled to find any plan that could provide a similar service to the NHS- and remember these plans often include NHS services such as hospitals, radiology departments and staff members, plus you still have to pay your taxes.

On an anecdotal level, people’s perception of private healthcare is wildly different from the view of healthcare professionals. If you are having a minor op, a knee replacement or hip replacement, by all means, you will enjoy the private side room, the better food, the quicker scans and appointments and physiotherapy. But, although it doesn’t seem like it to you, to any doctor you are relatively well.**

When you are really sick, when you need to go to intensive care, or are in a car accident, or have a life-threatening heart attack, seizure or head injury, you do not want to go ‘private’. You won’t want better food or satellite television and you especially do not want to be shut away in a side room- those are times when those commodities are dangerous. You want the same attention from teams of healthcare professionals that Joe Bloggs gets- because they deal with conditions like yours on a daily basis, and no one will ask you to mortgage your house to pay for it.

Myth #4

The NHS is failing

In 2010, according to the Kings Fund British Social Attitudes survey, public overall NHS satisfaction was 70%- an all-time high.

In 2013, despite a record fall, public satisfaction with the NHS was up to 63%, the third highest since records began in 1983.

http://www.kingsfund.org.uk/press/press-releases/public-satisfaction-nhs-stabilises-after-record-fall.

Over that same period NHS hospital workloads increased by 5.3%, treating 17.7 million patients in 2012/13.***

The bottom line: Despite year-on-year cuts in budgets, tremendous pressures on A&E, and a 5.3% increase in the workload of the NHS, satisfaction is still high.

In the meantime the government passed the Health and Social Care Act, of which reforms cost the UK taxpayer somewhere between £1.6 billion and £3 billion. The equivalent of 100,000 years of pay for a junior doctor, 100,000 free university places, 2 or 3 brand new hospitals or several round trips to the Moon. I honestly don’t know if this has had any beneficial impact to the patient in front of me, and I’d love to hear from any healthcare professional who does.

For me, the NHS, as it is for so many of it’s 1.7million employees, is more of an old friend. I love it and hate it, loathe it and admire it in a entirely different way to the people who come in and out for such a short time of their lives. For them it’s either the place that saved a loved one, or maimed them. I am honestly not in ‘support’ of the NHS or ‘against’ it. As ever, the real discussion is much more complicated. But please, be fair to it. It is it’s birthday today.

Juniordoctorblog.wordpress.com

*If you live in a country with a similar national institution that conjures such personal and idiosyncratic arguments as the NHS please let me know.

** And more than likely, although you won’t know it as you write your cheque to BUPA, you were seen by a consultant who works in the NHS, in an NHS hospital with an NHS operating theatre staff, anaesthetist and, especially, NHS junior doctors. For those of you not in the know, trainee junior doctors are not allowed to work privately, so any you see in an NHS environment are more than likely looking after you entirely for free. If you can point to any other organisation that would do that, I will eat my stethoscope.

***2009-10 there were 16,806,196 ‘finished consultant episodes’, which more or less means number of individual episodes of illness in NHS hospitals. In 2012-13 this increased to 17.7 million. http://www.hscic.gov.uk/searchcatalogue?productid=13264&q=title%3a%22Hospital+Episode+Statistics%2c+Admitted+patient+care+-+England%22&sort=Relevance&size=10&page=1#top

[1] http://www.theguardian.com/theguardian/2013/jul/05/nhs-national-health-service-beveridge-labour