Last week, a GP surgery in my hometown of Wellington announced that it would be closing next month. And it’s not the first – because, according to recent trends, it’s estimated that more than a thousand others have shut their doors across the UK in the last five years. Add to this the approximately six and a quarter million people who are currently waiting for consultant-led care, a number that, according to recent NHS estimates, appears to be on the increase, and it becomes evident that the National Health Service really is in crisis – and has been for some considerable time.
On the eve of the 1997 election, the year I became a GP partner, Tony Blair declared that the nation had ’24 hours to save the NHS.’ Today, nearly thirty years on, like those who lauded the emperor who paraded about town in his nonexistent new clothes, some politicians pretend they cannot see that the NHS is in the altogether perilous state of near collapse. One wonders if they have completed a DNAR form for the NHS without the agreement of those who love it most.
Be that as it may, what is certainly true is that the NHS cannot do all that it is increasingly being asked to do with each successive year. This is for at least two reasons.
Firstly, as science advances, more things become theoretically possible. But as Isaac Asimov once said, ‘The saddest aspect of life right now is that science gathers knowledge faster than society gathers wisdom.’ This is still true – not all that can be done should be done.
The second reason is, I think, more fundamental. We live in an increasingly anxiety ridden society.
Henry Thoreau wrote: ‘The mass of men lead lives of quiet desperation, and go to the grave with the song still in them.’
Undoubtedly some of us are indeed desperate. Lacking the fulfilment that we long for, but don’t quite know how to realise, we are increasingly anxious not to miss out on whatever it is that would give us satisfaction. By idolising absolute health, anxiety rises as our longing for the elimination of every problem – big or small, real or imagined – inevitably goes unmet.
The constant endeavouring to solve every problem is exhausting and counterproductive, for both those with the problem and those trying to do the solving.
In the last album he released before his death in 2016, Leonard Cohen sang: ‘There is a lullaby for suffering and a paradox to blame’. He was right. Because facing our weaknesses and accepting our suffering can be paradoxically comforting.
This is, however, a difficult philosophy to convey and one that is harder still to convince people of. So anxiety persists, together with its lonely companion, its accomplished accomplice, depression.
Anxiety in all its forms is now so pervasive that I think it easily represented the most common problem presented to me in my final years working as a GP.
Firstly, there were those who presented with frank anxiety – by which I do not mean to suggest that they had an irrational fear of Frank’s – be that Sinatra, Zappa or D. Roosevelt. I mean, instead, that they presented with clinical symptoms of generalised anxiety or panic attacks.
Then there were those concerned about symptoms that they feared represented serious underlying disease. And they were often hard to reassure, so twitched were they by the twitches that they experienced.
And then there were those whose presentation generated anxiety in me and those I worked alongside. Because healthcare professionals can also be left worried that they are missing something serious and fear what that might mean both for the patient and their own reputations – reputations that, myself included, they cherish, perhaps, more highly than they ought.
Put all these together and it seemed that almost every consultation had an agenda, hidden or otherwise, driven by anxiety.
I wonder how much of this is tied up with the prevailing postmodern notion of relative truth and its recent spawned offspring, ‘alternative facts’. We all know how recent years have been difficult, characterised as they have been by a global pandemic, financial difficulties, and numerous escalating conflicts, all of which perhaps do give us good reason to be uneasy.
But also concerning, and perhaps even more so, is the fact that a few years ago the Oxford English Dictionary made ‘post-truth’ its word of the year – a decision that reflected that public policy is being decided based on appeals to personal emotions rather than objective facts.
Paul Weller and ‘The Jam’ once sang, ‘The public gets what the public wants’ – and it seems today the public is at least sometimes promised what it feels it wants, independently of what it needs, because it is politically expedient so to do. And so I am left wondering if all the anxiety we see, and feel, stems from the fact that, along with the still clean bathwater of objective truth, we have thrown out the baby of any sense of assurance.
If nothing is certain, how can we not be anxious about everything – and how can we be reassured about anything? Because, with experts no longer trusted to know anything, what they know to be the case is now no more authoritative than what others only ‘feel’ to be true.
Our supposedly equally valid opinions serve only to trap us in a cage of constant concern.
Some years ago, I was surprised when my assurances, that a lesion on a patient’s scalp was a harmless seborrheic wart, were not accepted by the patient because her hairdresser had felt it was a skin cancer. But then, if truth is relative, my ‘expert’ opinion (and I use the term lightly) has no more authority over that of a non-specialist.
Similarly, another patient of mine once challenged a consultant cardiologist’s opinion that her ECG was normal, as she felt her symptoms were consistent with what she had read of Wolff-Parkinson-White syndrome. The objectively normal ECG, and the expert opinion of the consultant on that ECG, were both at odds with the patient’s feelings. And so a second opinion was requested, one that, when it was declined, prompted the patient to write directly to the consultant expressing her belief that her concerns were being ignored.
This notion extends to the anxieties that health care professionals experience too. If truth is relative, how can they have any confidence in what they consider to be true either – and if the patient feels differently to them, how can they say that they are right and their patient is wrong?
I am aware, of course, that there are, inevitably, times when a diagnosis is in doubt, when the truth is uncertain, but it sometimes seems to me that we are no longer prepared to accept that those working in the NHS know anything for sure.
And that includes the doctors!
Because in a society suspicious of intellectualism, the learned are themselves suspicious of their learning. I sometimes saw that in myself. Too concerned that my patients be happy with my opinion, my clinical diagnoses sometimes needed to be malleable, tempered to acknowledge the validity of the patients’ opinion regardless of how lacking in objectivity that opinion might be.
I doubt it was only me who has, on occasions, found myself kneeling at a patient’s feet and, whilst examining their sylph-like ankles, heard them reluctantly murmuring: “They are a little swollen I suppose”.
Of course it is no wonder that I and my former colleagues sometimes behaved like this, given how, for years, it has been driven into us that we should be more ‘patient centred’ – when of course, what we should have been urged to be was more ‘truth centred’.
But it’s arrogant to claim to be right about anything these days – facts prove nothing. In a consumer society, the customer is always right. Is it any wonder then that, as a result of medicine being opened up to market forces, the result has been that the patient now is always right too?
And if feelings are what are important, then what others feel about us becomes every bit as much an indicator of who we are as what we feel about ourselves. After all, a satisfactory review is sacrosanct – I’m OK, if and only if, you’re OK with me.
But if everybody’s feelings are different, how can any of us be OK – since how can any of us be OK with everyone? How can we make everybody feel positively toward us when they all have different criteria for what it is that would cause them to feel in such a way?
Anxiety is, I think, largely, a fear of unhappiness in the future which leads inevitably to us being unhappy in the here and now. That’s why anxiety and depression are such common bedfellows.
With the loss of religious belief, and with it the hope of a better time and place to come, society no longer is prepared to accept that we must sometimes wait for happiness. In an age when everything is instant, waiting is not an option – we must be happy now.
But in a materialistic, consumerist society, which daily advertises to us our discontentment by displaying what it insists we need, but do not have, to be happy, it is no surprise that we are anxious that life is passing us by, that we are missing out on being fulfilled today.
And of course it’s not just material goods that our society consumes. We consume health – it is the ‘must have’ we assume and insist upon. No suffering, however small, ought to be tolerated. We must have health and we must have it now – not next month, nor next week, not even tomorrow. The doctor must see me now – be it Tuesday morning or Sunday afternoon.
And so the National Health Service has become the National Health Slave even as the NHS itself, colluding with society that it can meet its greatest needs, slavishly insists patients behave in ways that current medical opinion dictates.
Don’t smoke, don’t drink, don’t fail to exercise, don’t eat just four of your five a day, and whatever you do, don’t forget your Vitamin D.
Don’t, don’t, don’t, don’t, don’t – and you might just live forever.
And so it seems to me that what this all ultimately boils down to the existential question of death. It is the one thing certain about life but we, increasingly perhaps, try to pretend that this too is uncertain as we pursue eternal life through medicine, lifestyle adaptations, and sentimental and fanciful notions of how those who undeniably have died, somehow live on.
In a world where nothing is certain, the certainty of death is above all to be doubted.
But we need to face facts.
Irrespective of how much money is pumped into the NHS to fund all that medicine increasingly can do, irrespective of how long GP surgeries are open or how short waiting times in A&E departments become, and irrespective of how much we heed medical advice and adjust our lifestyles accordingly, we will all one day die. And irrespective of what we may or may not believe about life after death, if we are to find any happiness in this life, we need to stop pretending otherwise.
We must stop believing that what we do will ever prevent the inevitable.
And so, rather than always looking to do more, if we want a population that is healthy in the fullest sense of the word, I think the NHS must judiciously look to do less and not, for example, insist on pointlessly prescribing a statin to my 94 year old Dad whose considerable age far outweighs that of his cholesterol, irrespective of how elevated it might be.
But this should not be seen as a call to abandon the NHS. On the contrary, it needs to be funded adequately – in order to do what a long hard look determines is objectively found to be important rather than that which is subjectively felt to be urgent.
We must stop pandering to ourselves who are too often intolerant of even the slightest inconvenience or hardship, and we must stop foolishly believing that by attending to our cholesterol, blood pressure, and vitamin D levels, all our future suffering can be prevented.
Why?
Because a good life is not solely determined by the absence of suffering – now or in the future. Unrealistic attempts to deny the inevitability of death all too often serve only as an expensive and time consuming distraction – one that compels us to look down at the temporary and trivial whilst neglecting to look up at the significant and satisfying.
We all need to learn to be less obsessed with the mundane and consider instead the transcendent. Only then will we cease from enduring an existence weighed down by anxiety and depression, and start enjoying a life buoyed by contentment and joy.
Related posts:
To read ‘The NHS Emporium’, click here
To read ‘The Dead NHS Sketch’, click here
To read ‘Monty Python and the NHS’, click here
To read ‘Docteur Creosote’, click here
To read ‘The Four Clinicians Sketch’, click here
To read ‘Mr Benn – the GP’, click here
To read ‘A GP called Paddington’, click here
To read ‘Paddington and the Ailing Elderly Relative’, click here
To read ‘Scooby Doo and the Deserted Medical Centre’, click here
To read ‘Dr Jonathan Harker and the post evening surgery home visit’, click here
To read ‘Bagpuss and the NHS’, click here
To read ‘the day LITTLE RED RIDING HOOD got sick’ click here
To read ‘The State of Disrepair Shop’, click here
To read ‘Jeeves and the Hormone Deficiency’, click here
To read ‘Jeepy Leepy and the NHS’, click here
To read ‘The Three Little GPs and the Big Bad Secretary of State for Health’, click here
To read ‘Mr McGregor’s Revenge – A Tale of Peter Rabbit’, click here
To read ‘The Scrooge Chronicles’, click here
To read ‘The Happy Practice – A Cautionary Tale’, click here
To read ‘The Three General Practitioners Gruff’, click here
To read ‘General Practices are Go!’, click here
To read ‘A Mission Impossible’, click here
To read ‘A Grimm Tale’, click here
To read ‘The General Practitioner – Endangered’, click here
To read ‘Dr Wordle and the Mystery Diagnosis’, click here
Some musings 