O’Mahony Seamus Head of Zeus, 2019, HB, 256pp, £20.00, 978-1788544542
Can Medicine Be Cured?, Seamus O’Mahony’s latest book is a very readable excoriation of contemporary medicine which appears to have lost its way. As the medical profession endeavours to manage increasing life expectancy and societal consumerism we become careless of things that can’t be measured like compassion and professionalism thus allowing managers, politicians and our patients to make anti-harlots of us all (more on that later).
The first part of the book covers the ‘golden years of medicine‘, the 50 years or so ending in the 1980s when, like the author, I worked in the NHS doing 1 in 2 on calls; not appreciating this might be as good an era for the medical profession as any before or since. O’Mahony then sets out contemporary medicine’s seemingly impossible challenges, noting the pointless progression of academic and research medicine influenced by Big Pharma. He is clearly exasperated by expensive follies such as the Human Genome Project with its, to date at least, limited application compared to the resources invested.
O’Mahony scrutinises data collection, application and the use of population studies; his account of The Mid Staffordshire NHS Foundation Trust Public Inquiry was particularly interesting, if again, disheartening. Like many, I had followed this enquiry of unprecedented mortality and accusations of institutional cruelty and callousness with alarm and accepted the damning conclusions of the Francis Report. Maybe I have to rethink this all again.
O’Mahony extrapolates politician Stanley Baldwin’s adage about the press (being like harlots exercising power without responsibility) concluding that doctors are now in the invidious position of being anti-harlots, carrying responsibility without power; in contrast to our patients who are now consumers with rights but no responsibility. This description delighted but dismayed me; it is just so apt.
At times the book becomes a bit of a rant but, sadly, I didn’t detect the author feeling any better after getting it all off his chest. However, it did make me feel better by articulating my own discomfort with our profession’s preoccupation with medical metrics and my increasing misgivings about protocol-driven medicine.
By this stage, more than three-quarters through, I was feeling the need for some relief from this brutal appraisal and ready for ‘the cure’ when came a chapter on medical humanities. I read on eagerly; this is my field, I try to get medical students to engage with the arts and humanities to better understand the state of contemporary medicine and society. However, O’Mahony is dismissive of this approach with its emphasis on enhancing empathy:
‘... glib customer skills and a superficial carapace of caringness.’
He notes our loss of compassion, sidelined in a medical system concentrating on measurable outcomes. I finished the book accepting there is no miracle cure for contemporary medicine. But O’Mahony suggests we may change gear and reach a new accommodation with the challenge. Citing the epidemiologist and statistician Major Greenwood, writing in the 1930s, he suggests contemporary medicine may not be able to ‘cure all disease’ or ‘defeat cancer’ but it can aim ‘to make the condition of human life everywhere more bearable’.
A good book challenges the reader, this book certainly challenged me but I feel better for engaging with this plausible and readable criticism of contemporary medicine. I have not felt that a book was written just for me, to make me engage with the difficult but compelling issues affecting my profession since I read Raymond Tallis’ Hippocratic Oaths: Medicine and its Discontents more than 10 years ago. Like the author, I often ponder that if I had known 40 years ago what I know now about the state of contemporary medicine, would it still have been my career of choice? For me the answer is still a yes, but I am aware it may be very different for the generation of doctors that follow.
The demoralisation of good junior doctors is a huge concern and I’m not sure we are as yet addressing it with the urgency it needs. With this book O’Mahony helps us look more clearly at the challenge.
- © British Journal of General Practice 2019