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Like John Launer, I bemoan the sacrifice of core values at the altar of s-called progress:-
When I was a junior doctor in South Africa in the 1960s, most patients who had been admitted to hospital remained under the care of the same healthcare team continuously, until discharge. In the Professorial Unit all discharge summaries were authored by the junior doctor. Throughout the year, at regular intervals, a departmental meeting was convened where we reviewed the discharge summaries in complex cases so that insights could be shared and lessons learnt.
I subsequently moved to the UK in 1974.
From 1979 until I became a consultant in 1984, I worked as a junior doctor in various NHS hospitals, including teaching hospitals. In none of those hospitals was it ever the case that departmental meetings were held to review the discharge summaries in complex cases so that insights could be shared and lessons learnt.
Subsequent to my retirement, I have discovered that it has increasingly become accepted practice for an inpatient (including an elderly inpatient) to make 2 or 3, or sometimes 4 transfers from ward to ward during the duration of the same hospital admission episode. This means that each of the junior doctors (and consultants) looking adter them only has a partial interaction with that patient, and no sense of continuity of the learning experience. In this assembly line model of healthcare no single individual takes ultimate responsibility either for learning or for teaching or for accountability. Even at the point of discharge the discharge summary may be authored either by physician associates or by departmental pharmacists.
In my own view, the greatest loss of the British healthcare system is the missed opportunity to learn from personal experience and the loss of opportunity to learn from sharing insights with colleagues. No amount of high tech gimmickry can ever be a substitute for that. So much so that I would advise international graduates who have made great sacrifices to acquire highly valued British medical qualifications to go back to their own countries for their internship, so that they can acquire the skills of continuity of care which have fallen into disuse in the United Kingdom.
Re: John Launer: Faces or candlesticks? Why we need continuity in teams;and lessons from a bygone era
Dear Editor
Like John Launer, I bemoan the sacrifice of core values at the altar of s-called progress:-
When I was a junior doctor in South Africa in the 1960s, most patients who had been admitted to hospital remained under the care of the same healthcare team continuously, until discharge. In the Professorial Unit all discharge summaries were authored by the junior doctor. Throughout the year, at regular intervals, a departmental meeting was convened where we reviewed the discharge summaries in complex cases so that insights could be shared and lessons learnt.
I subsequently moved to the UK in 1974.
From 1979 until I became a consultant in 1984, I worked as a junior doctor in various NHS hospitals, including teaching hospitals. In none of those hospitals was it ever the case that departmental meetings were held to review the discharge summaries in complex cases so that insights could be shared and lessons learnt.
Subsequent to my retirement, I have discovered that it has increasingly become accepted practice for an inpatient (including an elderly inpatient) to make 2 or 3, or sometimes 4 transfers from ward to ward during the duration of the same hospital admission episode. This means that each of the junior doctors (and consultants) looking adter them only has a partial interaction with that patient, and no sense of continuity of the learning experience. In this assembly line model of healthcare no single individual takes ultimate responsibility either for learning or for teaching or for accountability. Even at the point of discharge the discharge summary may be authored either by physician associates or by departmental pharmacists.
In my own view, the greatest loss of the British healthcare system is the missed opportunity to learn from personal experience and the loss of opportunity to learn from sharing insights with colleagues. No amount of high tech gimmickry can ever be a substitute for that. So much so that I would advise international graduates who have made great sacrifices to acquire highly valued British medical qualifications to go back to their own countries for their internship, so that they can acquire the skills of continuity of care which have fallen into disuse in the United Kingdom.
Competing interests: No competing interests