Healthcare is getting a bad press. In  any communally funded system, - that is every system apart from those rare situations where the patient pays individually for all the help received at the time -, the public , the payers, think we spend too much on healthcare and the patients in their need think we spend too little. Maybe healthcare is doing just fine! What else should we spend our money on? As individuals we all need a constant supply of air, warmth, water and food and would die if such supplies were interrupted. To do this requires a major part of our expenditures. After that in order of priorities would come health protection and healthcare. Well behind would come a vast raft of comparatively frivolous activities which we could probably cut back with no risk to our well-being or future prospects. Healthcare needs to stand up for itself and shout its case to the four winds. The public then might change its stance and better recognise the value of what we do.

Measuring Healthcare Quality

This is a report by the OECD which sets out the issues


 

Illness without (apparent) Disease

Healthcare aspires to help people who are ill - distressed or disabled. Often such illness is caused by disease - demonstrable disorders of the body. Healthcare is here at it's best. Many people with illnesses however show no signs of bodily disease. (In some cases doubtless there is disease which medical science cannot yet detect). Most such people however probably have no disease and here healthcare is at it's worst. It has a choice - up it's game, do the research and find better remedies or retreat and leave such illnesses to whomever might claim to help including sadly the grasping hands of alternative medicine which has no pretensions to effectiveness whatsoever. The money we spend on alternative medicine is huge and would be better spent within healthcare but healthcare has yet to decide if it wants this.

Experience

As healthcare changes, adopting increasing evidence for its interventions, there is a body of work trying to understand exactly how clinicians and their patients make individual decisions. There are five accepted influences at work. One of these is the experience of the clinician (and to a degree of the patient who may be in a position previously experienced)

Arguments for decision making less dominated by public knowledge, "evidence", talk up the value of the clinicians' experience. Is this warranted?

Feeding Babies

This is not strictly a healthcare issue but healthcare professionals do get involved. For a while the word was that "breast is best" and this got extended to the idea that small babies should be fed exclusively on breast milk. This advice was given to mothers. It seems now some work suggests that an earlier introduction of other foods may be useful and is associated with less food allergy later on. So science progresses. Is this the final word? Probably not. However this report set off a tirade from the midwifery profession. "What do these people know" "We know best and best is breast" etc. Here's the point. Midwives, and many other groups of healthcare professionals, deliver care and advice but have no developed mechanism to generate new knowledge. The midwives are not about to do the next piece of research to help get to the bottom of this yet they become vituperative when their current stance seem in need of change. They feel threatened. The core their professional status seems in question. "How could others know more about this than ourselves?" But of course they do. This situation is widespread and those groups afflicted feel the insecurity of their position and accordingly adopt unhelpful inflexible postures. Yet this will affect everyone as healthcare enters the biggest transformations in its history. We need to understand and attend to this situation.