The Reith lectures were inaugurated in 1948 by the BBC to celebrate and commemorate Lord Reith’s major contribution to British broadcasting. Many distinguished names are to be found in the alumni of lecturers, whose origins are not confined to this sceptred isle in which the concept of these educational, thought-provoking radio talks were conceived. The first lecture in 1948 was delivered by the distinguished philosopher and Nobel Laureate Bertrand Russell, who talked on ‘Authority and the Individual’, and subsequent talks covered in these lectures have embraced a wide range of topics from the arts, humanities, politics, economics, to the scientific disciplines often thought unfairly to be too abstruse a subject for the ordinary non specialist listener.
Medically-themed lectures have included the 1976 lectures ‘Mechanics of the Mind’, on the topic of brain and consciousness, delivered by Colin Blakemore, aged 30, and at the time the youngest Reith lecturer to Sir Ian Kennedy’s series on ‘Unmasking medicine’, which argued that medicine was too important a subject to be left to doctors alone. Steve Jones, in 1991, talked about the ‘Language of Genes’, and in 2001 the distinguished gerontologist Tom Kirkwood discussed issues about aging and man’s inevitable fate, in talks entitled ‘The End of Age’.
Atul Gawande, a Harvard Professor, distinguished writer, and last year’s Reith Lecturer, must surely be the first practicing surgeon to deliver these lectures. His topic was ‘The Future of Medicine’. The four lectures were full of good simple advice and we could all profit from some of the ideas discussed whether we are deliverers or consumers of healthcare. Dr Gawande’s great interest is in the currently fashionable topic of patient safety, and he has made important contributions in this area with his research and writing, and with the concept of checklists. Patient safety and human error are interlinked, and doctors fail because of the immense complexity of multiple tasks and processes involved in day to day patient care. Systems fail, although individuals often take the blame. He suggests that in the 21st century, the volume of knowledge has exceeded individual capabilities, and systems have to be designed to minimize problems.
Good healthcare systems require efficient, comprehensive, and accessible primary care systems with well coordinated patient pathways. In addition, safe hospital systems are needed to complement the primary care systems. Even simple tasks such as hand washing can make a difference. Constant encouragement is required to prevent staff burnout, and this happens because no one seems to notice excellence and tend to concentrate continually on negative aspects of healthcare. In addition, high technology medicine needs to be used with caution and appropriately with special reference to antibiotic usage, surgical procedures and imaging, areas which are growing unchecked in the Western world and will become issues in the developing nations too.
As societies age, end of life issues become important, and it is critical to acknowledge individual needs by simple tasks, such as asking patients what they want. Doctors need to talk less and listen more. We need to ask patients what they know and fear about their illness and what outcomes they are happy to accept. We need to refrain from ‘overmedicalizing mortality’,
The four lectures were illustrated with personal anecdotes and experiences, from the ill health of family members, as well as an interesting case from the history of medical imaging.
Gawande quoted the story of Forsmann, the maverick doctor from Eberswalde in Germany, who in 1929 performed a cardiac catheter on himself to push back the frontiers of knowledge and paid the price by being sacked from his job. Today this procedure is routine and saves many lives, but would mavericks like Forsmann be nurtured in today’s modern over-regulated climate?
Header image: Sound studi0. Public domain via Pixabay.
System fails and individuals take responsibility is an apt words. Better systems should be made.