It is hard to find anything in the Scotsman worth writing about. Newspapers and good journalism are victims of the medium I am writing in. But here is something. Sir Harry Burns, is stepping down from his role as Chief Medical Officer for Scotland, and taking up a position in Global Public Health at the University of Strathclyde. I am a little bit cynical about the academic bandwagon of ‘Global Public Health’. Much of it seems to miss the point that Sydney Brenner with characteristic insight made many years ago: the most common disease on this planet is MDD. Otherwise known as money-deficiency-disease. Correcting this is not straightforward— and medicine has an important, but limited role— but, as Bruce Charlton pointed out, industrialisation and capitalism has lifted more people out of poverty in the last quarter century (and hence cured more people with MDD) than public health research funding. Too often I am suspicious academics are trying to mine away at a newly exposed seam of research funding, rather that solve problems. Exceptions all around; Paul Farmer and the like, I accept. What however is worthy of mededed.me, is that Burns takes a broadside at the way we train doctors.
Looking back on his time as CMO, Sir Harry said there were still issues needing addressed. “I am not happy with the way we train young doctors now,” he said. “As I look at young people training in medicine now, I think their opportunity to do the kind of things that I have done, which has been a very varied career, I think those opportunities are harder to deliver now. “How they are trained now is very rigid. What I did in moving from surgery to public health would be really difficult now. “There’s an over-emphasis on ticking boxes, as opposed to encouragement of innovation and new ways of looking at your career.”
Well, I couldn’t agree more. But walk down any hospital corridor in Scotland and many doctors will tell you postgraduate training is a mess, and has been getting worse. Yet, each year, another report will spew forth from one of the various Bunkers in London, and yet more tick-boxing will be enforced, alongside more debasement of the English language. And the position in Scotland, under Burns’ watch, is arguably worse than in other parts of the UK. I used to wonder how people in the former eastern bloc melded official doctrine, with their private thoughts. How did they reconcile their inner beliefs with all the bullshit. I now know— as do a lot of doctors. Too much of medical education is about producing widgets for the NHS, wrapped up in an unwholesome diet of newspeak and doublethink. The problems are that we do not know what sort of widgets we might want, and second, many of us do not think medical education should be in the widget business. There is plenty left to do in the UK.