I am a big believer in Good Medicine.
Notice the capital “M”? We all know about “medicine”, which often takes the form of tablets that help you to get better. But Medicine is the art of getting people better. Learning Good Medicine is a process of skilled training that takes doctors decades of experience, practice, mistakes and reflection.
Good evidence = Good Medicine
It is impossible to practice Good Medicine without evidence – a fact that is drummed into us at medical school. Science is the reason doctors don’t try to cure impotence with electrocution, cure migraines by drilling holes in people’s skulls, and never encourage people to drink their own urine.
Look at some of these examples, to see how important evidence is:
Why do we ask Mrs Jones to take tablets for blood pressure?
Because the evidence shows that it reduces her risks of strokes, heart attacks, heart failure, kidney failure, and lots of other nasty things.
Why do we use paracetamol when little Timmy is burning up with his sore throat?
Because the evidence shows us that it relieves distress in children with raised temperatures.
Why does Mr William’s GP always ask him about smoking?
Because evidence shows that simple advice from a GP nearly doubles the chance that Mr William will quit in the following year.
Being a good doctor means practising Good Medicine. If we are going to take risks with people’s lives, we need to be sure that what we are doing is helpful; I’m sure you agree.
The government doesn’t have good evidence
Unfortunately, there is a problem. The NHS isn’t run by nurses, and doctors, and pharmacists, and radiologists, and dieticians, and the many, many other professionals who understand that evidence is the most important underpinning of everything we do together.
The NHS is run by politicians. Politicians like David Cameron, and Jeremy Hunt. Politicians who don’t seem to understand that Medicine without evidence is Bad Medicine. We, the doctors, are terribly concerned, that the politicians are in a hurry.
We want a 7 day NHS. Oh yes! We want a better health service, no doubt about it. But “7 day health service” is a buzzword. On its own, it doesn’t mean anything. Even if Jeremy Hunt sits on the toilet one morning, and has a brilliant idea, its very important that we test his idea.
Many of you will remember the incident in 2006 in London when a new drug, TGN1412, was given to 6 men, all of whom nearly died, with multiple organ failure. Ultimately, there was several problems with that trial, but a fact point is: aren’t you glad they didn’t try that drug on thousands of people at once?
The government isn’t proposed untested drugs, but it does want to roll out a junior doctor contract across the country, without testing it first. The junior doctors are concerned that it runs the risk of making problems much worse. Why is there such a hurry to take action without getting more evidence first?
What evidence we do have doesn’t support the government’s claims
Mr Hunt claims he has evidence that 11,000 people die each year due to weekend staffing. But let me read you a line from the conclusion of the very report he is quoting:“It is not possible to ascertain the extent to which these excess deaths may be preventable; to assume that they are avoidable would be rash and misleading.” In other words, he is claiming the study as strong evidence to support his actions: but the report makes it very clear that it is absolutely not.
Mr Cameron wants us to “become the first country in the world to deliver a truly 7-day NHS“. But he talks about 24/7 GP practices, despite the initial evidence we have not supporting this in practice. The Public Accounts committee grilled policy advisers on what their cost-benefit analysis evidence was, to discover that they haven’t done any. They asked a key question: “If you don’t know in broad terms what the answer is, how can you be doing the policy?”.
We would agree, strongly. If the government doesn’t know its changes will save lives, how can they be implementing them?
Why the junior doctors are striking
The government has said they are going to force a new contract onto doctors. But they don’t have any evidence that the new contract will save lives. We, the doctors, are very concerned that it will cost lives, and we keep saying it, but the government isn’t listening to us.
Knee jerk decisions?
That’s Bad Medicine.
Actions without evidence?
That’s Bad Medicine.
Changing the NHS that 53 million people rely on without trialling to see if the changes are harmful?
That’s Bad Medicine.
Bad Medicine kills people. Support your junior doctors, and tell the Government we want a safe, evidence based NHS, and we are willing to take the time to do it properly. #notsafenotfair