David Oliver: Conveyor belt medicine

Over the New Year period I worked three 12 hour stints on the acute medical unit. What I saw, heard, and felt over those days, and over many others this winter, was nothing unusual for colleagues in acute care throughout the NHS. What it perhaps resembled most was an out-of-control conveyor belt, of the kind used to tragicomic effect by Charlie Chaplin in the 1936 film Modern Times.1 This one wasn’t carrying parts needing screws, however, but sick, frightened, or confused patients and their worried relatives. The operatives in this case weren’t depression era factory workers but clinical staff, struggling to deal with the relentless procession and unable to stop it.

We know that each clinical encounter really matters to patients and their relatives. It will be …