The best medicine

Emyr Gravell

For many of us it's the funniest programme on radio. So, a few weeks ago, I joined 2000 other fans in the Millenium Centre in Cardiff to watch a live recording of ‘I'm Sorry I Haven't a Clue’. It is the the self-styled ‘antidote to panel games’, the original spoof quiz show which now has many imitators. Despite being around for over 30 years it's still fresh and brimming with sharp humour, the panellists include both older and younger generations of comedians and it has broken down the distinctions between traditional and alternative comedy.

Laughter, like music, is often thought to be an escapist pleasure, a frivolous add-on to life, but it has a much deeper value and is a fundamental part of what makes us tick. It it is more than an antidote to the vagaries and frustration of day-to-day life. George Bernard Shaw said ‘When a thing is funny, search it for a hidden truth.’ Great humour is usually great because it touches on great wisdom and truth, often bringing to light things that straight-faced seriousness hides.

For me the funniest panellist on the show is Barry Cryer, perhaps not the most familiar name but in fact the comedy genius behind many of the more familiar comedy stars of the last 50 years. One of those he used to write for was David Frost, at that time a powerful media mogul who could make or break careers at a stroke. Barry Cryer tells the tale that, in keeping with this image, Frost owned a sleek powerful sports car. It was open-topped but it had a switch on the dashboard in case it rained. If it did start to rain he just flicked the switch and the rain went away.

I see this as a picture of the problems with political–managerial controlling culture that's taking over medicine. A culture that doesn't seem to recognise that there is a limit to how much we can control the outside world. We should celebrate the fantastic success modern medicine has had in dealing with the suffering illness brings: I would much rather be ill today than even a few years ago. But we haven't got a switch to make disease go away.

Despite great advances in medical knowledge many of the problems our patients bring do no fit neatly with this knowledge, and unless we are honest about our limitations we will get more dissatisfaction. It's a paradox that as medicine achieves more, dissatisfaction seems to increase. The politicians' response to perceived failings is to pour more and more energy into tighter management, more control and monitoring, leading to structures like QOF. The unrealistic expectations of change that this approach actually brings to the real world often fuels the fire it is trying to put out. John Major said that if the answer to a question was ‘we need more politicians’ then the question was wrong, I think the same applies if the answer is ‘we need more health initiatives’. As the great Muslim poet Yusuf Islam said ‘Oh, baby, baby, it's a wild world’. Only people who stay away from real patients with their personal, often protocol-defying problems can believe that enough training, organisation, management, and control of maverick doctors will tame this wild world.

General practice is about individuals trying, sometimes struggling, to help other individuals in an imperfect world and there is a limit to what we can change. We can't make the rain go away, we need to concentrate on building the best roofs that we can. If we want to stem the dissatisfaction with what medicine can't do, we need the wisdom to know when to invoke the antidote to over-optimistic progress and say ‘I'm Sorry I Haven't a Clue’.