Some musings

I won’t keep you. I know you’re busy, crazy busy – possibly busier than you’ve ever been before. Certainly the NHS and its 1.7 million employees are. There were 24.8 million attendances at A&E departments last year and more than 312 million visits to general practices. Demand is increasing faster than the chronically underfunded NHS can cope with and waiting times for some services have increased way beyond what is remotely acceptable. With up to 40% of GP consultations now being related to mental health, the local wait for NHS counselling services is too long to be useful and it seems likely to lengthen as society fractures further. Attention needs to be given to the causes of both physical and emotional ill health and the extra funding needed to provide the necessary resources to attend to all these very real needs must be forthcoming if we, as a nation, want to be considered a caring society. But, rather than just charging the NHS to solve our problems and demanding our politicians provide the funds for it to do so, what else, if anything, can be done to ease the load?

As I say, we’re all busy – it’s not just the NHS – and none of us are happy about it. It’s hardly a surprising statement and neither is it a new problem. Back in 1660 Blaise Pascal wrote:

‘I have often said that the sole cause of man’s unhappiness is that he does not know how to stay quietly in his room’.

We are too busy to be happy. But interestingly Pascal asked the question as to why we are busy and came up with the answer that we keep ourselves busy to distract ourselves from the fact that we are ultimately going to die. He writes:

‘Despite [his] afflictions man wants to be happy…But how shall he go about it? The best thing would be to make himself immortal, but as he cannot do that, he has decided to stop thinking about it.’

Now what I find interesting is that the world of medicine is inordinately busy pursuing that same illusion of immortality – trying to deny what we do not want to think about, namely that we will all one day die. And it has got itself into all kinds of trouble.

Atul Gawande, in the first of his 2014 Reith Lectures, asked the question as to why Doctor’s fail. In it he spoke eloquently of how, as the body of medical knowledge increases, the ability to be aware of it all, or apply it all in every situation, becomes increasingly difficult. Furthermore, he explained that, because science cannot tell us everything, since each of us is unique, we cannot have omniscience.

The medical profession fails therefore, not only because of its underfunding, not only because of its ignorance and occasional ineptness but also because of its necessary fallibility. Medicine, you see, is not the answer to the problem of our mortality. Though this may be hard for us to face, one thing at least seems certain – because of it we will continue to suffer and die.

Society has bought into the lie that perhaps in years past we doctors have been guilty of encouraging – that we have godlike capabilities, that medicine can solve every problem. Hence the increasing demand that the NHS is all too evidently experiencing. And because that expectation has taken too firm a root in the minds of some patients, health care professionals can find themselves charged with being infallible and, as a result, increasingly find themselves being criticised for failing to be so. No wonder the recent reports of decreased satisfaction in GP services.

Putting ones ultimate faith in doctors is never wise because, despite our best efforts, suffering in life is, sadly, inevitable. And yet too often, our patients, and we doctors, busy ourselves trying to deny the fact. Denying the reality of death, too many have become intolerant of even the slightest suffering and we have become unable to accept our inability to relieve it. As a consequence of becoming too busy chasing absolute health, too many make it increasingly difficult for themselves to enjoy being mortal – and we make it harder four ourselves to enjoy being doctors.

Pursuing immortality, we have become dissatisfied with mortality.

Attempting to avoid death, we have forgotten what it to live.

And busy chasing a happiness defined by the absence of imperfection, we are rendered more unhappy than ever before.

So what is the answer to our busyness? Could it be that, rather than pretending we have the answers, we need to acknowledge our ‘necessary fallibility’ – rather than frantically attempting to deny the inevitable, we need to face up to the reality of suffering and death and become more realistic in our attempts to avoid it? Counterintuitive though it may seem, might we be happier if we accepted suffering, and even death, as part of life?

We live in a world which constantly massages the truth, portraying real life as more ideal than it is – take advertisements, the ‘beauty’ industry and our own Facebook profiles. Medicine must stop airbrushing reality and be honest enough with society to acknowledge what some of us know all too well – that suffering, though an unwelcome aspect of day to day existence is, none the less, one that cannot be avoided. If we stopped demanding that medicine correct every spot or blemish, remove every ache and pain and curtail every cough and sneeze, might we not be freed up to enjoy life more and, at the same time, free up NHS time and resources for the care of those with more pressing concerns?

The NHS still won’t be able to make all things well – we’ll have to put our faith elsewhere for that – but we will have helped an overburdened NHS cope with the demands placed upon it rather than having added still further to its load.

And we all might be a little less busy – and a little more happy.

[Updated 30th November 2019]

References:
Pascal B. Pensées. 1660.
Gawande A. Why do doctors fail? BBC Reith Lecture – 25th November 2014