What do you tell students about the future?

I was gossiping with a bunch of fourth year students the other day about what medicine might look in a few years, and how possible changes will affect their lives and careers. Big topic, with few certainties. One of the clear messages was that they felt that nobody really critically talks about these issues to them. Instead, there appears to be lots of what might be called soft propaganda: how there is a shortage of GPs, and how important it is for them to serve by becoming these GPs; how the UK model is self-evidently superior to that available in the rest of the world; or denial of the observation that people voting with their feet (as in migrating) is one of the key ways human societies advance. Despite the ‘global health’ movement, they seem to know little about how health care is organised in different countries, especially those just across the channel. And they seemed interested to know more, so I suspect the fault is ours, not theirs. Little is done (it seems to me) to move beyond the tired stereotypes of US medicine (show your credit card or you will be declined emergency care etc) on the one hand, and the NHS ‘free’ but ‘world class‘ health care on the other (world-class, along with ‘holistic’ is the canary in the mine for bullshit). 

Such views are of course lacking in depth. Much of mainland Europe provides lessons for how to provide good health care and maintain solidarity across social strata. Anybody who knows a little about health care in England (think, Circle and dermatology; and NHS dentistry) knows that it is likely that for much of their careers many of our students might not be employed by the NHS, but by private for profit corporations, and that the exercise of monopoly power by government is stronger now than ever. The main political parties in England want to privatise health care, and seem to believe that corporate culture plays no role in delivery of ‘any service’: Virgin, United Health Care, it is all just the same, or so New labour believed. Waitrose, or Walmart: it doesn’t matter! Just look at Steve Ballmer and Steve Jobs: clones aren’t they? When independent regulation has been lost, and most health care is delivered by the same organisation that controls training in ever more microscopic ways, economics 101 will make predictions about what will happen to salaries and working conditions and —here is the crunch — how providers will manipulate customers / clients / patients. Indeed, gossip to many doctors in any hospital and you can make guesses as to what awaits many of these young people. For some for them, Australia seems closer than it did to me. 

We need to educate our students to look to the world, not their own backyards, something that Scotland was once very proud of. I have just shown a US visitor the plaques on the wall of the old Edinburgh Medical School in Teviot Place, commemorating the contributions our students made to both medicine and society (ies) across the world. Not one of them, a ‘widget’, I wager.