How to make yourselves redundantBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4706 (Published 08 November 2018) Cite this as: BMJ 2018;363:k4706
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As well as the preventive measures documented surely diet and exercise should be highlighted (in case they were included in 'education' and 'social improvements'). Britains were never healthier than in WW2 with rationing and the need for (increased) physical activity. Glasgow used to hold the dubious record for dental caries due to the ships from the West Indies unloading their sugar with resultant 'sweetie shops'. Today, however, there is an epidemic of obesity and the consequent 'Diseases of Affluence' (hypertension, hyperlipidaemia, cardiovascular diseases, diabetes, arthritis and depression) due to the oversupply of processed foods, better public transport, labour-saving devices including mobile phones and computers, The cost of the drugs to treat these preventable illnesses is absolutely incredible. Yet, in many parts of the civilised world, nutrition and physical education have been lapsed from the school syllabus while TV ads for junk food are designed especially to attract children. The politicians bury reports criticising processed foods as the Fast Food Industry makes incredible donations to their Parties.
It has gone past the point of no-return such that prevention is now up to the motivated, (already) educated individual who are mostly restricted to Socio-economic Classes 1 and 2. As to the rest then, cynically, may I observe the various Governments have adopted the policy of "Let Them Eat Cake (and other Fast Foods)".
Competing interests: No competing interests
After somehow managing to get 2 postgraduate degrees, in addition to my first in Pharmacy, the first 12 successful years of my career were mostly in the Pharmaceutical Industry. Initiated after a relatively short but most rewarding period with the DHSS Medicines Division; now the MHRA, as one of the first three Scientific Officers employed to assist Medical Assessors. Employment was more varied for the following 10 years.
It became rapidly apparent, although I did not realise this until many years later that I had developed skills that set me apart from many of my peers. In particular: organisational; lateral thinking; ability to work on my own without continual guidance and an enduring trait of never being a 'yes man' and prepared to speak my mind to far more senior individuals than myself. As a result I was able to find (or they found me) projects of significance to do, mostly on my own, to initiate and manage change.
The first simple example of these was a new job reviewing preclinical toxicology reports prior to allowing them to be passed to Regulatory Affairs for submission for a Clinical Trials Phase approval, or Product Licence. Given I was female and had never actually worked in an actual industrial toxicology department my many comments for improvement in all aspects of long detailed reports with detail down to individual animal data, were not appreciated. The response was a slow improvement in the quality of the reports received for review such that after two years not only was the role becoming boring, so I had been looking for other 'tasks' to keep me occupied, I essentially became redundant.
Over the years I became an individual 'special projects' resource. Each project that seemed to last around two years and had some endpoint that became clear as it progressed if not obvious from the start. My achievement was the realisation that I had succeeded in what I had been asked to do, or identified as needing to be done. I rarely got any reward or even thanks; this was often taken by the particular boss at the time.
20 years later I had achieved a great deal for companies, but my reward was for the stress and anxiety and far to much working 24/7 that I completely burnt out.
What I have noticed in my local area also is that there seems to have been a direct correlation in the amount of hours put in by clinicians to their huge rises in remuneration over the last 20 - 30 years. The more pay - the less hours, working to contractual hours or many individual arrangements with less days per week, since they probably do not need the money to still have a rewarding out of work lifestyle.
As a result the availability of GP time has decreased at a faster rate to the increase in patient numbers with health problems. (My own analysis, not supported by any reviewed evidence). It is becoming less and less likely that these GPs, Surgeons and Consultants will suffer any 'real' issue with individual overwork; nurses, registrars and support staff in the NHS are not included in this.
They are putting into practice what is 'preached' to the current working population of the UK, but the latter are now working 24/7 more and more, just to survive. On the other hand GPs are becoming more and more difficult to actually see face to face with telephone triageing becoming the norm, sometimes with life threatening misdiagnoses based on these assessments, plus the assumption that a patient is always able to define one problem at a time, when many may be interrelated! Nothing will replace a face to face consultation and these are now to time limited. The growing numbers of elderly will probably find on-line AI questionnaires difficult, if not impossible to complete anyway!
So to agree, in part, with one of the respondents above. The role of a GP, or hospital clinician, may involve ongoing small successes. However, these are replaced on a daily basis by new challenges, some never resulting in making a patient well. The changes in lifestyle and work ethic of the 21st century population is changing at a rate that GPs will find it harder and harder to ever achieve many small successes, let alone become redundant.
Competing interests: No competing interests
In an ideal world the doctor is challenged to make their patients well. Indeed if they were to do so to the fullest extent there would be less demand for their services. We can dream about how every mother would give birth to healthy babies by natural methods of child birth, how we would live healthy lives until the day when we expire, and how we can make people well; however the real world situation is complicated by the growth of the world's population, the steady increase in levels of pollution - today it has been announced that fertility has halved in recent decades. There is a worldwide shortage of doctors moreover the demand for healthcare keeps increasing. In brief there is never going to be a situation when the doctor is made redundant.
The latest announcements re AI technologies which will replace the GP are just marketing hype. The fundamental process means that there is always going to be a limit beyond which the chatbot cannot go beyond - it is limited by the existing state of knowledge (the etiology of most medical conditions remains poorly defined, especially so re complex chronic conditions), and the ability of the patient to relay details about their health to the examining chatbot. Indeed this limited state of knowledge is the reason why there continues to be so much medical research. As stated by Einstein 'if we knew what we are doing it would not be called research'.
You might think I am arguing against a new generation of AI technology which can diagnose the patient's health. No. I am arguing for a new generation of medical technology - based upon a precise and sophisticated understanding of what the brain does and how it does it i.e. a mathematical model of how the brain regulates the autonomic nervous system and the coherent function of the physiological systems - and how this can be applied with diagnostic and therapeutic effect.
Ewing GW, Grakov IG, Mohanlall R, Adams JK. A Clinical Study Report and Evaluation of the Ability of Strannik Virtual Scanning to Screen the Health of a Randomly Selected Cohort of 50 Patients. J Neurophysiol. Neurol. Disord. 2017;4:1-12. DOI:10.17303/jnnd.2017.4.101
Grakov I G, Graham Ewing, Mohanlall R, Adams J K. A summary or meta-analysis of data regarding the use of Strannik Virtual Scanning as a screening modality for healthcare. Asian Journal of Pharmacy, Nursing and Medical Science 2017;5(3):55-71 http://ajouronline.com/index.php/AJPNMS/article/view/4636/2521 .
Ewing GW, Grakov IG (2015). A Comparison of the Aims and Objectives of the Human Brain Project with Grakov’s Mathematical Model of the Autonomic Nervous System (Strannik Technology). Enliven: Neurol Neurotech 2015;1(1): 002.
Competing interests: CEO of Mimex Montague Healthcare, suppliers of Strannik software. Strannik, the first technology to be based upon a mathematical model of how the brain regulates the autonomic nervous system and how this can be applied with diagnostic and/or therapeutic effect.
"Matt Hancock, called for a greater focus on prevention (doi:10.1136/bmj.k4684). If properly funded and implemented over time, this should indeed help more people to keep away from doctors." For a while. Not forever.
It is pleasing to think that good health begets decreased costs. However, all will die and most will do so of a chronic disease preceded by medical treatments. Living longer as healthy people generally does generate additional expenses as well. (1)
(1) van Baal PH, Polder JJ, de Wit GA, et al. Lifetime medical costs of obesity: prevention no cure for increasing health expenditure. PLoS Med. 2008;5(2):e29.
Competing interests: No competing interests