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LETTERS: Michael Baum Ramifications of screening for breast cancer: Consent for screening BMJ 2006; 332: 728 [Full text]

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Ramifications of ‘Them and Me.’

William G Pickering   (28 March 2006)

Ramifications of ‘Them and Me.’ 28 March 2006
William G Pickering, Doctor 7 Moor Place, Gosforth, Newcastle upon Tyne. NE3 4AL Send response to journal: Re: Ramifications of ‘Them and Me.’	Ramifications of ‘Them and Me.’ Professor M Baum autobiographically tells us that ‘Working at the "sharp end" provided me with a somewhat different perspective to the epidemiologists, managers, and other servants of the state who served alongside me’. It is perhaps surprising that it required Baum to be appointed to a national steering committee before he realised the implications of his ‘different perspective’. He defines that they ‘worked alongside me’ rather than he alongside them; which may bespeak part of the problem. Until clinicians, of all ranks, realise their modus operandi and conclusions are special often only to them, and that unless they communicate such items to lay persons in jargon-free language (be they patients or ‘servants of the state’) then medicine will continue to be perceived, except by doctors, as esoteric and impenetrable; which it is not. Baum informs us that he is ‘quite numerate’. If only he were also ‘quite’ aware of the sometimes diffident world around him. The same world which pays his salary – for he, though it appears to have been overlooked by him, is a ‘servant of the state’ too. He may then, over his working lifetime, have dutifully informed it, utilising all the humility and patience he can summon, of his views. Only by decent and regular communication by doctors can patients and steering groups be kept in the picture. Sometimes it seems that doctors aim for a "them and us" battle. Baum, being ‘a thorn in their side’, resigned from this battle with the committee — an ‘honourable’ action, he confides. Their fault presumably. On medical matters is it always the bureaucrats, ‘servants of the state’ and non-clinicians who are at fault? Or are they victims of impatient perfunctory medical explanation (caringly delivered, of course)? Patients may have a view on this. The ‘ramifications’ of Baum’s ‘different perspectives’, avoidable though they could be (were there a will), pervade a myriad of diverse issues. Whether ever-rocketing health costs are of the slightest relevance to better practice, if doctors and the state don’t understand each other, is but one. Even doctors have occasionally to be spoon-fed information, sometimes spoonful by spoonful over a considerable time. Not even they can always perceive or learn what is best instantly — as, for example, the gradual change from radical to often much less radical surgical intervention for carcinoma of the breast perhaps helps illustrate. William G Pickering. e: wgpi@hotmail.com 27.3.06 Competing interests: None declared