Safety before Convenience

What we need from healthcare is complex and many of our requirements conflict. We surely want healthcare to be safe and we also would I am sure prefer it to be reasonably convenient. But if the two conflict? It is becoming clearer that complex interventions are more safely provided in centres with a significant throughput where the experience of the teams builds up and adds to the overall quality of the work. This move to fewer centres conflicts with the convenience enjoyed by many populations who had smaller centres in their midst. Because healthcare in an open public system has every decision scrutinised by the public this demand for local provision acts as a brake on improving safety. We need as individuals to be better informed of the issues to help us support rational developments.

Sociology in Healthcare

Healthcare starts with a desire to relieve human suffering. Its great triumphs have come where that suffering is caused by some abnormal bodily process - a disease. Addressing disease will frequently relieve suffering in a major and prolonged way. But not always and often not before additional suffering has been caused for example by surgery, chemotherapy or radiation. Many patients bring their suffering to healthcare in search of relief yet are disappointed when healthcare finds no disease which it can address and consequently often contributes little to the patients well being. This group of patients may be numerically the most common and there is an urgent need to understand what causes such illnesses. The supposition is that there are psychological and social factors at work. To understand such illnesses healthcare needs a working partnership with social science. Sadly this has thus far proven impossible. There are of course lots of sociologists with an interest in illness but there activities are ill co-ordinated with healthcare and they seem to pursue an isolated agenda, heavily laden with sociological theory and deficient in any serious volume of empirical data. In short they approach the problem with the superior air of a group who know the answers but in reality they contribute little to patient welfare resting content to have, to their own satisfaction, confirmed the correctness of their theories.

This will not do. Healthcare must find and work with sociologists who will approach the task with some humility and open mindedness. We need to improve the help we can give patients whose illnesses are not rooted in bodily disease. We need to work with sociologists to produce useful knowledge and ultimately rescue patients from the embrace of the multitude of deceitful charlatans who currently take their money and give nothing in return.