do no harm

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All compassion is self-pity 

- D.H. Lawrence

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The lady in the public health lecture mentions something about 'case-finding' and how it's different from normal population screening. The idea is, she explains, that by using factors like smoking and body mass index and previous hospital admissions, you can identify asymptomatic people who are at high risk of developing a serious illness. GPs would then phone them up at home and construct a 'virtual ward' to take care of them in the community, in theory pre-empting hospital admissions by picking up and treating illnesses early. My first reaction to that is 'whoa hold on... you mean to say we're having enough trouble treating the present sick and dying population adequately, and yet you now want doctors to invade people's homes and look after the healthy? Maybe we're going about this the wrong way.'

Maybe the reason the NHS is stretched so thin is because we are trying so hard - maybe unrealistically - to cure everyone and keep everyone healthy. Endlessly optimizing. We're trying to export franchises while our flagship branch is going bankrupt. Buying assets with money we don't have. The idea is that prevention will help save money in the long run, but we spend so much money on trying to save money. It feels a bit like those promotions where you buy 10 more items to qualify for a 10% discount. Are we really saving, or just spending more? The costs of living in a too-health-conscious society. It's obviouslyh better to prevent hospital admissions and to treat patients in the community - to preempt the disease, but there is a cost as well to both patient and doctor by effectively having a patient take up residence in the practice, just in case he/she catches a cold. Is that what the NHS is doing right now? Inspecting every nook and cranny for potential maladies and bringing to a 10 minute consultation a laundry list of benign lumps, problems and worries.

Our resources are being stretched thin, reducing our pay to provide more services and facilities. Telling a starving man to eat less to save money to buy more food. We are looking to expand our kingdoms while our castles are crumbling. Why don't we focus on what we already are trying to do. Why don't we focus on doing that properly first. You learn 3 chords on the guitar and decide to pick up the harmonica. Just because you can do something, doesn't necessarily mean you should. Maybe we get greedy and overlook the risks of treatment, the harms of over-diagnosis, Sometimes doing nothing is the lesser of two evils. Maybe we forget. You can't learn everything. You can't save everyone.