Harry Palmer
I was born in 1944 in Manchester, UK, four years before the introduction of the National Health Service. At the age of two or three, I entered into a relationship with the medical profession when I was taken to a doctor’s surgery by my mother.
Though no more than a toddler, I have a couple or three mental images of those times and the image I have of Doctor McDermott is of a tweed-suited, waist-coated (with pocket-watch chain across his middle, of course) middle-aged gentleman – Conan Doyle’s Dr Watson might have been a caricature of him – sitting in front of shelves full of books and behind a busy desk.
Novelists I read years later exemplified to me the practice of medicine in those days and the characteristics of those heroes I also recognised in Dr McDermott. These novelists included W Somerset Maugham (Of Human Bondage), who trained and qualified as a doctor at St Thomas’ Hospital in London; Sir Arthur Conan Doyle (Sherlock Holmes stories), who trained and qualified as a doctor at the University of Edinburgh Medical School; and A J Cronin (The Citadel and The Stars Look Down), who trained and qualified as a doctor at the University of Glasgow. These doctors were trained in the early-to-middle 20th century.
Doctors like mine were professionally autonomous men and women who carefully examined the patient and usually came to an incontrovertible diagnosis and then a decision was made on the proposed treatment – or if further specialist examination was required – without having to meet targets and fill in unnecessary forms or jump through metaphorical hoops, as required today by administrators in the public health sector, who, in turn, are hounded by managers whose minds are focused on abstract matters such as money. Those ‘old-fashioned’ doctors were compassionate people, who, if not of the Christian faith, were adherents to its principal belief of ‘loving one’s neighbour’, and whose training included understanding and accepting the principles of the Hippocratic Oath. Nurses were similarly inclined.
Britain and New Zealand have changed since that era, and particularly in the past 40 years. The New Zealand Government’s sell off of the ‘family silver’ of power generation companies, railways etc, in the last few decades, was one obvious change, but not, perhaps, the most far reaching. Another ‘improvement’ across New Zealand’s businesses, manufacturing and medical cultures was the government’s adoption of “International Standards” in the 1980s. The introduction of these standards has, in my view, stifled creativity and increased both mediocrity and the subservience of business to the government of the day.
These international standards, although possibly justifiable for companies operating in a competitive international market, were also forced on internal businesses, especially those providing goods or services to government, both local and national. You will have no doubt seen the proud declaration on vans and letterheads of such businesses as being compliant with ISO 9001, etc. What this means is that the business, from top to bottom, has been inspected/audited by an outside organisation and their ‘findings’ compared with the vaguely worded ‘International Standard’: a guideline document issued by the International Standards Organization (ISO). Adjustments may have been made where indicated by the auditor in order for a business to be issued with a compliance certificate, and now the holder can tender for, for example, government work. Ongoing maintenance of that compliance also requires that a company’s subcontractors are also in compliance with the same international standard.
See what happens when you’re not looking? The government seeks to push its ISO requirements all the way down the chain of suppliers, from banks to office-cleaning companies. Though the uptake and upkeep of these standards might have fallen somewhat in recent years, the audit/clipboard mentality it introduced still prevails and allows government ‘nudging’ – you must adopt and document ESG, affirmative-action, anti-racist, equality and diversity policies, etc.
I suggest it’s probably not wise to have outsiders of unknown allegiance spying on, criticising and meddling with the internal workings of your company, nor to have a ‘clipboard clown’ looking over the shoulders of professionally qualified and registered workers, critiquing them and reporting perceived failings to management (not to mention the demeaning of an employee’s contribution to the business).
In my former area of work, skilled, time-served, engineering staff (who had completed an indentured apprenticeship) were required to write out a very detailed description of each job they carried out (eg stripping a diesel engine and its re-assembly), then management converted the written results into ‘operating procedures’ – a major requirement for ISO compliance. They then made the skilled staff redundant and promoted their untrained assistants to their positions, monitored by senior personnel holding the appropriate operating procedure, with tick boxes next to each stage of the work, on a clipboard. What did the union guys have to say about all this? They were the ones given the clipboard job.
I understand that you can still serve some sort of ‘modern apprenticeship’, but, as in other professions like nursing, pharmacy and medical practitioner, the one-on-one learning ‘on the job’, backed up with proportionately less time spent on academic stuff, was a feature of traditional methods of training, but this has since been replaced by such nonsense as ‘nursing degrees’. The holders of such, as could have been expected, tend to scorn the practical aspects of job stuff, like cleaning up puke.
And so went ‘the dignity of labour’, having a ‘calling’ and taking pride in your work. Mostly gone are those willing to stand up against the enforcement of top down ‘management’, and they will soon all be gone, too. Wisdom is no longer a valuable and respected virtue: it’s the ‘thinks he knows it all’, selfish, loud-mouth – usually younger – person who rules the roost. It’s little wonder, then, that many of my generation view doctors these days as little more than agents for the pharmaceutical manufacturers, who seem to have a pill – and vaccine – for most occasions. From there, it’s surely not a great leap in imagination to envision the introduction of an upgraded, coin-in-the-slot machine that can diagnose your illness in a short conversation, then pop the appropriate pill in its delivery tray.
With machines increasingly taking over one side of conversations that used to take place person-to-person, on the telephone or via email, and now, as proposed (however distant it may seem), robotic doctoring, human nature slips further into the void.
I see that the UK’s NHS is adding another category of ‘medical professional’ that will, no doubt, be seen here in New Zealand. After importing staff from eg India and the Philippines for many years, instead of recruiting and training native Brits to those jobs, supplies are beginning to dry up. The new job category is ‘Associate Doctors’ or ‘Physician Associates’, who, with a couple of years’ training after a biology degree of some sort, will be able to segue into work normally carried out by a registered medical doctor.
I should think that Doctor McDermott, Somerset Maugham, Conan Doyle, A J Cronin and their ilk would be – as would be many of the members of today’s medical profession – horrified at what their once noble calling is turning into.