Abstract
I was pleased today to read the article by Dr Lakhani on optimistic medicine, 1 praising the last 40 years of medical advancement in the face of the global pandemic. Yet, as a soon-to-be doctor myself, I found myself confused at the overarching ideology behind this article.
The article poses the question: ‘So why then are doctors so unhappy?’ The answer to this, however, seems to be written between the lines. Are doctors powerless drones, trapped in a Kafkaesque red-taped labyrinth of regulation? Or are doctors driven-down pessimists, who are too busy and culturally negative to step back and see the big picture? Or are they both?
The article then, agreeably, poses the answer: ‘there is a mismatch between doctors’ ambition for their patients and their ability to translate this into day-to-day practice’. However, the article later then calls for proactive leadership and ‘rediscovering Oslerian values’. It seems as if doctors are the ones to blame for their own suffering here. Are doctors ambitious but powerless, or pessimistic and disengaged?
Similarly, this article condemns the long research to practice gap and supports cultural change to the ‘art of medicine’ and relieve the shackles of a ‘hostile regulatory environment’. This is backed up by the seemingly ludicrous medicine of four decades ago. However, is this calling for a loosening of evidenced-based medicine? There seems to be a mourning for a culture passed, where doctors were optimistic artists – while simultaneously condemning the medical practice of those days. Should we regulate our research for best practice, or is it more red tape to cut through?
The words ‘optimism’, ‘culture’ and ‘values’ litter this article, and give a sense of optimism being a progressive and forward thinking ideology that is yet to be clutched by doctors. Personally: seeing my friends and colleagues volunteer for extra shifts, create communities online supporting local key workers, all while risking their own lives was an indicator that optimism is not in short supply.
I would argue that a cultural shift is not what is required, but a managerial one. Perhaps a healthy dose of pessimism may allow us to realise why the underpaid, overworked NHS doctors are switching continents and careers.
