PRIME - Healthcare inequalities: Closing the gap

Healthcare Inequalities - Closing the Gap

For this month's message, I was struck by something Bill Gates said recently. Talking to students at Harvard (from where, incidentally, he dropped out over 30 years ago before graduating) he said;

"The barrier to change is not too little caring; it is too much complexity."

PRIME cares passionately about this and tries to help correct the balance by making training available to all, but it seems to me this sentence has a lot to say about healthcare generally. Great technological innovations and the advances of medical science have created a world in which we can see disease in terms of a disordered cardiogram tracing, changes on an MRI or biochemical results beyond the normal range.

This would be fine if that was how disease presented. The sheer complexity can often get between us and the realization that illnesses occur in real people and present as symptoms and dysfunction, not as statistical data.

Sir William Osler, the so-called "Father of Modern Medicine", insisted that the best "text book" for students and residents to learn about disease was at the bedside of patients talking to them in depth.

"Listen to your patient and he will tell you the diagnosis"

But so often the complexity of diagnostic lists and investigations diverts us away from the big picture and we can so easily lose our sense of the personhood of our patients. As healthcare professionals, we need to know the science and the technology available - but this should be as a tool in diagnosis and therapy and not allowed to submerge the essential relationship between patient and carer.

In Nepal after a PRIME seminar on post traumatic stress disorder, a psychiatrist said, "I knew all that, but I knew it as lists - now I understand it!" and a year later said, "That seminar changed my life. I consult differently - and I have taught the department to do so too."

We must always remember not to let the complexity of our calling hide the humanity of the patient - and ourselves.

At the end of his talk, Bill Gates concludes by asking the graduates to consider how they will look back on their careers in thirty years time. "I hope you will judge yourselves not on your professional accomplishments alone, but also on how well you have addressed the world's deepest inequities… on how well you treated people a world away who may have nothing in common with you but their humanity".

Quite a thought!

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