‘While public dissatisfaction is high, Beijing sees improving healthcare as critical to maintaining social harmony. However, many interactions between healthcare staff and patients are far from agreeable, with hundreds of attacks on healthcare workers every month. Many doctors say the last thing they want their children to do is study medicine.’ FT

Just an everyday observation. Awhile back I sat through two hours of what can best be described as a project management meeting. Twenty people or so reviewing pages of protocols, adding a bit here and there, but seldom taking anything out. The process stretches forward over a timeframe of months or years. A central (but unspoken) problem being that the attempt to capture clinical encounters, involves formalisation and summarisation, resulting in few participants actually knowing what the clinical context will be. All laudable work, all designed to improve things.

When I returned to base I could observe the environment one single doctor found themselves in. One harried ‘junior’ doctor, literally running between a room full of students whom the doctor was attempting to teach; an on-call phone that kept going off; an on-call patient being seen at the same time in another room; a simultaneous polite query about drug dosage via pharmacy; and doctor acting as porter and nurse wheeling patients from one room to the next. Model that.

In less than a year, Regent had gone from about 10 such students to well over a thousand…For-profit Regent is one of several London colleges to have made Pearson’s HND central to its expansion plans. In 2012-13, funded HND and HNC student numbers at private colleges in England increased seven-fold from 2,600 to 18,000, with more than £130 million being issued by the SLC. Another college that mushroomed was St Patrick’s International College, which took its HND and HNC intake from 50 to more than 4,000 in that one year. THE

“History is full of examples of young people who were working on important problems that no one else at the time thought were important, and in particular that their parents didn’t think were important. On the other hand, history is even fuller of examples of parents who thought their kids were wasting their time and who were right……Parents can sometimes be especially conservative in this department. There are some whose definition of important problems includes only those on the critical path to med school.” Paul Graham on terrific form

“While technology is not the only enabler of change in higher education, it is on the critical path to all foreseeable change,” Rich DeMillo

“Liston operated so fast that he once accidentally amputated an assistant’s fingers along with a patient’s leg, according to Hollingham. The patient and the assistant both died of sepsis, and a spectator reportedly died of shock, resulting in the only known procedure with a 300% mortality.”

— a short history of surgery

“Stop thinking as a subject matter expert and start thinking as a designer. ” I agree, but would put the word ‘solely’ after the first ‘thinking’. Link.

There was an advert in the BMJ a few weeks back for an academic vascular surgeon at a certain UK medical school. The blurb included the following two phrases: ‘you will be able to define, develop, and establish a high quality patient-centred research programme’, and ‘in addition to the above, you will be expected to raise substantial research income and deliver excellent research outputs’. Chew on that, and any of you still  thinking of a career in science, read this: ‘How Academia and Publishing are Destroying Scientific Innovation: A Conversation with Sydney Brenner‘, one of the handful of scientists who made the revolution in biology in the twentieth century. I don’t think he will be applying, (and not just because he failed his undergradaute surgery exam first time round).

“Once you start letting a government monopoly instrument – the income tax system with an income-contingent loan – be used by private interest groups like the universities, then you can very likely end up with a situation where the instrument itself becomes a [means] to seek rent from students.” And there would be “questions about the ethics” of that, he said.

Bruce Chapman

Well,  this did make me laugh. You cannot think about modern medicine without thinking about the generation of new useful knowledge, and how we can parcel out what knowledge we already possess and package it so that those with fewer experiential skills can use it. The latter is a bit of a mouthful, but I mean breaking tasks down such that they can be accomplished by those with less (expensive) training. So, do you need to be a dermatologist to undertake skin surgery: the answer is clearly no, but the exact answer  depends on exactly what type of surgery. There are parallels in other professions, such as using paralegals instead of lawyers. I cannot remember my sources but I think doctors made up around a  third of the health care workforce a century ago, where now it is 1 in ~14. This trend will continue, and our friendly machines will be looking for work too. Students be warned.

So, I was following up on this theme with some background reading, Race Against the Machine and all that. And I came across a study by Carl Benedikt Frey  and  Michael A. Osborne  with the title The Future of employment : how susceptible are jobs to computerisation? I cannot speak to their methodology, but they have come up with probabilities for how likely various jobs are likely to be replaced by the dreaded machines. What made me smile was that the estimate for ‘Medical Scientists, Except Epidemiologists’ was p=0.0045, but for Epidemiologist it was 0.2. Chuckle.