From a nuanced review of ‘Let me heal: the opportunity to preserve excellence in American medicine’, by Kenneth Ludmerer.
The advent of prospective payment in Medicare that ensued, followed by the rise of managed care, signaled a new regime for hospitals, which Ludmerer aptly terms the “era of throughput.” For residency programs, this has generally meant the end of reflection, study, and searching, and of late-night conclaves among house officers and their mentors about the nuances of patient care. As the au- thor has warned previously, it has also meant that education has taken a back seat to the pressure to admit and discharge patients as rapidly as possible.
I think the same is true of the UK. It is all throughput, with education and training taking second place: the obsession with the present, precludes a sensible future. Good care is defined by ‘thoroughness’, and it is increasingly hard to find. None of these changes should be viewed as anything but predictable. ‘Era’ as in ‘error’.