Heroes and villains

Craig Watson

In the real-life equivalent of computerised flight simulations, high-flying pilots launch their smart bombs on distant and defenceless populations. In the real-life equivalent of computerised economic simulations, high-flying politicians launch their smart policies on distant and defenceless populations. Neither in simulations nor in real life do those individuals at the launch sites hear the screams of those affected at the point of impact.

The perfectly performed sound bites of an orchestrated media campaign provide mellow music to muffle the screams. On virtual reality television, newscasters interview ministers who massage us with their figures. Their reassurances proclaim that ‘the world is safe in their hands’ and that ‘the NHS is safe in their hands’. Meanwhile, going virtually unnoticed from their vantage point, from every direct hit of allied ordnance, another suicide bomber emerges from the wreckage. And from every shrinking NHS waiting list, another elderly lady endures years of pain and immobility awaiting her hip replacement operation. Just to be on the safe side, ministers agree funding to fortify Westminster and Holyrood, and to facilitate patient transfers from NHS waiting lists to the private sector. Actions speak louder than words.

Doctors are by and large a conservative bunch, upholding the rules that rightly dictate our professional activities. And by the rules, we negotiated the new GMS contract that promised to change the face of General Practice and improve services for patients. However, many of the prizes promised to our negotiators remain elusive. That cornucopia of new money, the ‘global investment guarantee’, has not provided me with the new staff, IT, premises, services and freedom from out-of-hours work I anticipated. My health board still expects doctors, staff and patients to make do and mend for the foreseeable future. You may criticise my impatience, but no matter how far ahead I look, I see no convincing signs of government conviction to alter course. What went so wrong with the negotiations to leave us in the same dire circumstances we hoped to escape? Were our negotiators heroes for securing the contract, or villains who failed to deliver their promises? I believe they worked diligently in the best interests of their profession and their patients. My concerns lie in the rules and timetables by which they were forced to negotiate.

If we need new heroes to champion the cause of our profession and our patients, then whom should we look to: Superman, Wonder Woman or Shrek? What about Captain James T Kirk of the Starship Enterprise? In one childhood memory of mine, he faced annihilation at the hands of an intergalactic adversary. He confided in his crew that he had never really faced death before; he had always cheated and defied it. When he had to perform on the computer simulation used by Starfleet Command to prepare captains to face such dire circumstances, he confessed that he hacked into the computer the night before and rewrote the software to create an escape route. He earned a Starfleet Commendation for his initiative and ingenuity.

You may scoff at my choice of hero as a fictional cheat, and question his relevance to the future of our profession and our patients. But surely fictional heroes and their exploits are simply an amalgamation of real-life heroic attributes and deeds, portrayed by the characters' creators with a little artistic licence. Maybe Nelson Mandela would inspire more confidence. Imprisoned as a national threat, he became a respected world leader, rewriting his country's constitution because he could not accept his status as a second-class citizen. Or what about Charles Darwin? Facing derision as an anti-Christian heretic by the establishment of his day, his published studies rewrote the perceived wisdom on the origin of species, becoming accepted as scientific fact.

Heroes do not play by the rules or follow the terms of engagement and timetables of their adversaries, nor do they follow predetermined paths to foregone conclusions. Heroes create their own rules, and they shape their own destinies. In a profession that advocates lifelong adult learning, who can question my portfolio for including a few pearls of wisdom from childhood memories of television adventures and history books? If we live in a time where there is more truth in the story of an imaginary space traveller using a computer simulation than in the declarations of politicians elected to represent their constituents' best interests, then how should we respond? I suggest that we urge our heroic medical representatives to apply themselves to the task of rewriting the rules and destinies of our profession, based on the values we and our patients hold dear, to give us all an escape route from our current dire circumstances.