Abstract
There is no doubt that the medical profession is in a state of flux with malaise and disenchantment. The pre-existing low morale amongst doctors, coupled with the COVID-19 pandemic, has caused considerable uncertainty about the future. The profession is again faced with the million-dollar question – what is the way forward? And what is their role in defining the post COVID-19 world?
The COVID-19 pandemic has united us, and we should be proud of the courage that the medical profession has shown. Strong collaborative leadership from doctors has enabled the NHS to tackle the pandemic surge. This paper suggests that now is a big moment in the history of NHS to reimagine healthcare and set an unapologetic, optimistic direction for medicine. It aims to stimulate a discussion on how doctors can overcome barriers and lead change rather than accepting the NHS ‘old-normal’ as inevitable.
While it is important to acknowledge the realities of working in a fragmented health care system that is under-resourced and overwhelmed by demand, it is also essential to write and talk about the good things that have happened. As working doctors, we marvel at the many of the epoch-making treatments that we can now offer patients. We have personally seen the lives of patients with conditions such as inflammatory bowel disease, psoriasis, and ankylosing spondylitis transformed by biologic agents.
In mental health, there are compelling examples of individuals who have flourished through better diagnosis and treatment with modern drugs and talking therapy. The stigma surrounding mental health is reducing, partly due to large social media campaigning.
Less than four decades ago, many patients with cancer died early; peptic ulcers were treated by surgery, and heart attacks by bed rest! Now, many cancers are much more likely to be cured (if detected early), peptic ulcers treated by helicobacter pylori eradication, and heart attacks by percutaneous coronary interventions and highly effective secondary prevention drugs. We are undoubtedly already in an age of progress in medicine. Just look at many of the things that we can offer patients such as earlier diagnosis, high tech investigations (when needed) and curative therapies. Moreover, we are seeing empowered patients who have increased access to high-quality standardised care with a focus on prevention and wellbeing.
So why then are doctors so unhappy? One reason, in our view, is that there a mismatch between doctors’ ambition for their patients and their ability to translate this into day-to-day practice. This leads to doctors feeling discontented and frustrated. As working doctors, we want to do even more for our patients as we are acutely aware of the big translation gap between research and practice.
Merely doing more of what we currently do, and even if done better, is not going to be enough. The opportunities to improve the system are vast. Significant changes are of course, necessary – at pace - for funding, infrastructure, workforce and technology and innovation. But work and money alone are simply not going to be enough. There is a need to find common purpose and values.
Proactive leadership by physicians to set a new direction for medicine is now urgently needed. This new direction involves rediscovering Oslerian values such as clinical reasoning, excellence in care, research, patient-centeredness, and pride for the profession. With newfound confidence, we can embrace a different risk appetite that will allow us to defeat the twin scourges of modern healthcare of defensive medicine and overdiagnosis. Wider cultural change is needed that supports the freedom to practise the art and science of medicine in a less hostile regulatory environment.
The future direction of medicine must embrace artificial intelligence and virtual care. There is a compelling argument made by Eric Topol in his book Deep Medicine that the use of AI can make medicine ‘more human’ by allowing us to spend more time with patients. Imagine the power of big data that integrates genotypes, phenotypes, clinical, lifestyle, and environmental information to support precision and predictive medicine. In the future the role of doctors will become even more critical, focusing on shared decision making, managing complexity, and ambiguity
The key to optimistic medicine is the wellbeing of doctors and their sense of empowerment to influence change. Improvements in the day-to-day- working lives of clinicians are desperately required. Tackling high workloads, burnout, and providing access to high quality and responsive information technology, including less clunky electronic medical records, is a must. The use of the GMC’s ‘ABC’ approach will be critical (autonomy, belonging and competence) together with a focus on the so-called ‘hygiene’ factors.
Let us reimagine the culture of healthcare, one that enables doctors to thrive. Constitutional change may be needed to enshrine an enhanced role for doctors in leadership in all sectors of the NHS.
Doctors are so busy with their day to day lives that sometimes it is difficult to stand back, appreciate the good things in medicine and see the big picture. But this they must do at this opportune time and shape the future. It is such a good time to be a doctor, and there is enormous potential for better care. We call for a movement for positive or optimistic medicine as a legacy of COVID-19 to bring about a resurgent medical profession.
