Departure time 2023, arrival 1943
Timothy Garton Ash in the NYRB
When I started writing my book Homelands: A Personal History of Europe five years ago, I thought that in order to bring home to young Europeans the horrors against which postwar Europe has defined itself, I must hurry to track down some of the last surviving elderly Europeans with personal memories of the hell that was Europe during World War II. So I did, in Germany, France, and Poland. But today all you need do to experience such horrors firsthand is take a train into Ukraine from the southeastern Polish town of Przemyśl. Departure time 2023, arrival 1943.
Don’t aim to work in the NHS
A little while back, Lisa and I were out for dinner at a friend’s house. The mother, ’M’ was a doctor and the husband, ‘H’, worked in finance. M ticked all the boxes for what you might wish for if you were a patient: technically competent, deeply caring, and worked way beyond her contractual hours. Nor did she park her patients in some tidy box somewhere: her job was part of who she was.
M and H had a few children under 11. As often happens, while watching the children play and interact, the question was asked what they might end up doing as a career. H spoke immediately and with conviction: ‘I just hope neither of them ever works for the NHS.’ Note, not I hope they do not become doctors, but rather I don’t want them ever working in the NHS.
I find it hard to imagine this same conversation a quarter-century ago. Things have changed.
Training is in tatters as doctors prioritise urgent care and discharges | The BMJ
“During my last job on an acute medical unit, one of the FY1s would sit in a box room separate from the doctor’s office for three days a week and write up to 15 discharge letters a day. It’s farcical to suggest that’s rounded training.”
…
“Prioritising training for juniors isn’t just about having competent and confident doctors in the NHS but actually having them at all. It’s hard to feel compelled to pursue a career in the NHS after a week in which your sole learning point was how to make the ward photocopier work,” she said.
A dog at the master’s gate predicts the ruin of the state. (William Blake)
Rees’s law of education
(After a John Hennessy quote that the time to assess a Stanford degree is ten years (or more?) after graduation).
Any real education is incapable of a robust widely accepted psychometric assessment of the sort that will satisfy a professional regulator.
Another formulation:
If you can reliably assess knowledge within a standardised and regulated framework it is not education.
Plain silly
He imagines a day when teachers could use AI to create individual lesson plans for every student, or nurses might be able to take on much greater roles in, for example, diagnosing diseases. “Why is it that nurses cannot prescribe medications? Why must everything go through this very hierarchical approach where you have to call a doctor [to do that]?” As it is today, the people who spend the most time with patients — nurses, not doctors — are those who are paid and valued the least. Using technology to empower such workers would raise overall productivity and quality of care while also raising wages.
Why not? Simply because doctors and nursing are complementary professions. If you do the prescribing and diagnosing, you become the doctor. The danger is that the whole ethos of ‘caring’ — what was once so central — is being lost. I remember the teaching point: nurses sat on beds talking to patients without seemingly doing anything else are working.
The book the FT is reviewing (Power and Progress: Our Thousand-Year Struggle Over Technology and Prosperity) has been well received but the argument behind this quote seems to me very superficial.
My disease is more important than your disease
Acute myeloid leukaemia – The Lancet
Acute myeloid leukaemia accounts for over 80 000 deaths globally per annum, with this number expected to double over the next two decades. The 5-year relative survival for patients in the USA diagnosed with acute myeloid leukaemia is currently 30·5%, improved from only 18% in the year 2000.5
Sometimes raw numbers — rather than rates — are appropriate. But not often. Instead, I suspect authors quote raw numbers to bolster ‘importance’. I have even see figures projected into the next quarter century. Why stop there, why not the next century?
In general and in this case the authors should have quote mortality rates. The standard, which usually works is per 100,000 of population. In the case, AML, a truly dreadful disease has a mortality rate of close to 1:100,000. The rate figure allows easy comparisons with other causes of death without having to check on the population numbers of the world population or other denominator.
It just bugs me. The Lancet is full of this sloppy editing. And how much of the projected increase is due to changes in the age structure of the world population? Yes, it all matters, but the frequent coupling of partisanship and hype needs a polite divorce.
The medical student as ChatGPT
I am amused that people are slow to realise that large language models (ChatGPT etc) do not understand what they are saying, or that they make things up — that is, they hallucinate. Performance on “surface layer” testing does not equate to competence. Anybody who has taught medical students knows that humans are quite capable of exhibiting the same behaviour. It was one of the values of the old fashioned viva. You could demonstrate the large gulf between understanding (sense)on the one hand, and rote — and fluent rote at that — simulation on the other (garbage).
The medical educationalists, obsessed as they are with statistical reliability, never realised that the viva’s main function was for the benefit of teachers rather than learners. It is called feedback.
The medical student as ChatGPT