Valuable thoughts

By | 1st May 2018

I recently attended a training day for GP trainers which was all about the arts. Apparently, today’s doctors have been so focussed on getting to medical school that they have not had the opportunity to study the arts and that hole in their learning is now being shored up by their GP trainers!!

Now you may be wondering what good comes from your GP knowing his Rembrandt from his Hockney? The arts, I now know, is a way to getting to understand the human soul. And I think the lecturers have a point, I have probably quoted more Shakespeare in the Denmark Doctor than I’ve quoted any scientist or doctor. Shakespeare had an amazing knack of describing the inner workings of human beings in a direct and succinct fashion.

A doctor who studies the Arts should be better able to empathise with the extremes of human emotion which we encounter every day and so be a better doctor. I’m not entirely convinced by this argument but I do think that having a broad education simply makes you are more balanced person who is better able to appreciate people who may have had very different experiences. In other words, you are more open, tolerant and understanding and less prejudiced – all of which is essential to being a doctor.

I confess that I’ve had a bit of a cultured month having also visited the British Museum. Alas, I didn’t really feel like a culture vulture most of the exhibits just looked like old bits of stone, they certainly didn’t move my soul. I did, however, connect with my inner Victor Meldrew when I saw some priceless exhibits which seemed to have more jewels than the crown jewels.

My mind then went off on a flight of fancy regarding government austerity measures, the national debt and so on. I presume the majority of the priceless contents of the British Museum are owned by the state. The vast majority are locked away in its bowels and hardly ever seen apart from a few ‘lucky’ researchers. I asked myself what is the point – why don’t we simply flog the lot? Sell everything that’s locked away in all our museums and galleries and in the process clear the national debt?

All we need to do is keep a few replicas to keep the punters happy, no need to tell anyone because let’s face facts when you’re looking through glass at a sparkly stone, cubic zirconia will be pretty indistinguishable from a diamond. Then  I realised the rather obvious flaw in my cunning Baldrickian plan – to quote Blackadder ‘it’s so bleedin’ obvious that someone will have done it already.’

The only question is how long ago we sold everything. However, my flight of fancy didn’t stop there. We made a mint privatising gas, electricity, phones, steel, rail etc why not privatise government. We can keep a prime minister and give her/him a veto but otherwise, the rest could go to the highest bidder. The thought of ministers having to hit unrealistic targets and being trimmed down to the bone is quite appealing.

Alas ,I’m not sure there would be many bidders for the Department of Health with the present perilous state of the NHS. Of course ,the government are in the process of privatising the NHS through the back door – its strange but with all the other privatised national institutions we did make a sizeable profit ie investors were prepared to pay good money to take them off our hands. Oddly the backdoor privatisation of the NHS seems to be achieved by us paying private companies?

All this has got me thinking about what is really of value, what is truly valuable. Wouldn’t it be good if we were getting value for money out of the NHS? But alas with constant political interference it’s almost impossible – at the last elections, I voted for the Pirate Party solely because they had a policy of basing their policies on proper evidence – which is something that our present political system will never deliver. I am amazed that we still deliver a national breast screening program.

The evidence shows that the program doesn’t save lives. However, it will be political suicide to shelve the program – the reason is that it does appear to diagnose breast cancer early which results in an increased survival rate for breast cancer.

It is only when you look at the overall death rate for everyone who goes through the screening program that you appreciate that the death rate is unchanged – in other words going through breast screening is good for some people but bad for others who inadvertently die prematurely from unnecessary interventions. An evidence-based government would have axed the program after 5 years. Thankfully we have been much more circumspect with prostate cancer screening which still doesn’t show any overall benefit.

Perhaps the most important question I should ask myself is how valuable am I? My narcissism is not quite in the Donald Trump, Vladimir Putin or Tony Blair league, any one of whom I suspect would think that selling themselves would be quite sufficient to clear their respective countries national debt. I mean how valuable is a doctor? There is no doubt that if you are anyone but a member of our illustrious government, then you would almost certainly put our value right at the top of a league table of worthwhile jobs. But the bottom line is that although we may be very valuable to some people at some difficult times in their lives in the greater scheme of things our value is very limited.

Just imagine that all the doctors in the UK disappeared overnight, or maybe we were never invented in the first place. How long would it be before anyone realised we had gone? OK so a few people would know quite quickly but most illnesses are self-limiting so it wouldn’t really make much difference. Almost all of the 25 years increased life expectancy over the last century have been down to social and technological revolutions and not medical science.

If I’m brutally honest on a population level medicine doesn’t really matter that much. On an individual level, it matters a lot – I would have been dead at least a couple of times and one of those when I was less than a month old! But most people don’t have to have lifesaving surgery. Now imagine a different profession, refuse relocation services or environmental protection services or whatever euphemism you choose to give people who collect our rubbish. Society does not value people who collect rubbish the same as people who operate on brains – the latter group is paid at least 20 times more.

But consider this, how long would it be before people realised that refuse collectors had disappeared. We would be oblivious to their loss for about a week, thereafter things would be very different – within a month we would be overwhelmed with rats and epidemics. When you look at value from this perspective we really should be paying the opposite way round?

So what are your values? This easy question is often really difficult to answer. All economists know that values are dependent on your circumstances. Most people think of diamonds being worth much more than water, but if you are dying of thirst in the middle of a desert? I see many people who are really stressed with work, they spend 90% of their waking hours at work and never really question themselves about why? Most people find that life just takes them on a journey trying to find enough money to pay for their lifestyle.

When you are in such a situation it is almost impossible to change. But sometimes the pressures become too great and the stress is overwhelming, which is when your GP becomes more important to you than the refuse collector. Our strategy to help you to get better is to reconnect you to your real values. There are a couple of questions I pose – firstly imagine you are fast forwarded to the end of your life, what will be in your obituary, what would people read in the local paper about you? Is that what you want people to read about you? Or do you want a different life story?

Secondly, I ask you to imagine that I’ve just told you that you have a terminal illness – you are going to die in 6 weeks but you will have no symptoms at all ie you have the opportunity to live life to the full. What will you do with that time? I’m yet to meet anyone who would spend that time going to work. I’m convinced that many of the emotional problems which often result in physical symptoms are due to a serious disconnect between people’s lifestyles and their personal values.

Do you honestly know what is important to you? Are you living a life which is consistent with your values and how you want to live your life?

 

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