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Everything That’s Wrong With Society

November 19, 2012
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I do so love the Daily Mail. I marvel at how it can publish such balanced, fair and accurate news every day to further the general enlightenment of the population. What’s more, its online wing, ingeniously titled Mail Online, brings a touch of class to the internet that would otherwise be degraded by the guttersnipes that sniff around Twitter and Reddit.

Apologies. Until The Medical Student starts printing such prose in a special font, you may have missed the sarcasm that lightly dusted the previous paragraph. I have always considered the Daily Mail to be a fount of twisted and poisonous invective, filled with thinly veiled close-minded bigotry. Occasionally, if I happen to come across a copy (I refuse to buy the rag), I experimentally peruse the pages to see if my hypotheses about its bilious nature remain true. They unerringly do.

For some reason, the Daily Mail has a particular grudge against the medical profession. With a roughly predictable periodicity, they will trot out a flat-pack manufactured ‘outrage’ against the amoral and overpaid doctoring class. The scars left after its savage attack on the drinking culture at my own beloved ICSM are only now beginning to fade. Back in June, it lambasted the industrial action led by the BMA after stagnation of negotiations on NHS pensions. It was quick to paint a picture (in broad strokes, going outside the lines) of avaricious doctors putting Mammon before patients, on top of their already bloated salaries. The Daily Mail is a newspaper that will not let the truth stand in the way of a good story, or at least a good rant.

Interestingly, they are not against medicine itself. Though nowhere near as regular as the Daily Express, they routinely feature stories of up-and-coming wonder-drugs and new miraculous properties of super-statins. At times like these, I am reminded of Davies’ law of novel pharmacology: any given drug on the horizon is more likely than not a mirage.

The latest target to draw its Sauron-like ire is the Liverpool Care Pathway. This is a protocol that strives to ensure terminal patients achieve in their final hours that holy grail of clinical excellence, quality of life (and, dare I say it, dignity). Lines are removed, invasive and unpleasant medications and investigations are called off and in their place, pain, nausea and fear are attended too. It is not the withdrawal of care but the shifting of its goal from cure to comfort.

In typical Daily Mail style, the LCP has been demonised as widespread euthanasia of the elderly. Once again, doctors play the bad guys, aping Shipman in choosing death or life for their geriatric patients. In a marvellous coup de grace, they have highlighted the fact that NHS Trusts receive financial incentives for the numbers of terminal patients on the pathway and painted as payment to clear beds with extreme prejudice. Money-grubbing and playing God, a two-for-one! Horror story anecdotes are being trotted out under such titles as ‘I Survived The Death Pathway!’

Other newspapers like The Daily Telegraph have jumped on the lynch-mob bandwagon but I blame the Daily Mail as the instigator. In fairness, if doctors are putting patients on the Liverpool Care Pathway prematurely or unilaterally, then, yes, that is a minor outrage. However, the reality is very likely the opposite.

With the exception of those in palliative care and oncologists, doctors don’t like death. That’s understandable. In the glory days, heroic doctors could outwit death with effective antibiotics or ground-breaking surgery to save the acutely ill patient. If the patient died, that was a failure on the doctor’s part. Unfortunately, while we are still running around hospitals pretending to be Dirk Bogarde’s Dr Sparrow, the reality of medicine has moved on. In the developed world, chronic disease in one form or another makes up most of the business. Old age too, and all its attendant derailments, forms the basis of many a ward round these days. With this clientele, we shouldn’t be surprised that our patients die. Furthermore, we shouldn’t see it as a medical failure. Instead, it is a medical reality.

But it’s wrong to think that it just doctors working on the ward of wishful thinking. We are part of a society that refuses to acknowledge death. Part of this is to do with the over-estimation of what medical science is capable of. If doctors, who (should) know their limitations, see themselves as failures in the face of death, what can we expect from a public whose only exposure to medicine is Casualty and House?

A larger issue is the super-immediate ‘now-ness’ of modern society. In an age of fast food and fast cars, we can have the latest model of anything the moment the whim takes us (personal finance willing, of course). If it breaks or gets lost, get a new one, bigger and shinier than before! The next paradigm-shifting gewgaw will be out in three months but you’ll be long bored before then. Nothing need last. Films are pacier and books are snappier than ever.

And don’t even get me started on the internet, which has thrown the process into warp drive. Take, for example, Twitter, which I adore – constant immediacy.

The point of this quickly unravelling rant is that our long term planning has become increasingly myopic. From childhood, we are aware we will die, at some unspecified day in the distant future. But instead of planning and meditating on how we should like to die – the Ars Moriendi of an era past – we ignore it and buy the new iPad instead.

The consequence of this is that we ignore death and it becomes a pitiful and frightening experience in a hospital bed. We ignore the ogres which lead us there, chronic disease and old age. Thus, as doctors and as a society, all three take us by a surprise. The Liverpool Care Pathway is a sensible and sensitive alternative to fumbling around at the end. It allows both patients and doctors a chance at dignity in the last hours of their care.

With such a noble goal, no wonder the Daily Mail is furious.

This article first appeared in the November 2012 issue of The Medical Student, the newspaper for London medical students.

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3 Comments leave one →
  1. Anna permalink
    November 20, 2012 5:23 pm

    Be careful in dismissing this .yes the dialy mail may not present the most a balanced arguments available . But there are enough families , with enough concerns , genuine complaints involving end of life care of there family member that this will run its course , the LCP will be reviewed and improved and other necessary processes reviewed inc communication. So the truth will out -the dialy mail or your opinion aside ,The pallative care community recognise this need so your opinion is not professional and maybe come back to this when you have had a relative die and have had 15 years clinical experience as medical consultants have also stood up and spoken about this .

  2. Kathleen permalink
    November 21, 2012 6:39 pm

    Oh, not another medical student or FY1 making comments about things they don’t understand! You’ve barely left school and you are suddenly the world expert on death and dying. I’m sick of people slagging off the Daily Mail. Patients and relatives of dying patients phonedd the DM so that someone would listen to them and investigate what’s happening in our hospitals. The LCP is misused and abused, when are you going to get that into your thick heads. Are you too pompous and arrogant to step back and look at the picture from a different perspective?
    No consent is given for the LCP. You need implied consent to cannulate, take bloods, catheterise, give IV fluids and a 101 other things you do to patients but not when you put them on the LCP. Did you not think about that? It’s OK because it’s not your relative or friend, you just believe everything you read in the BMJ or Lancet, believe everything your senior Drs say.
    “Thoughts are like butterflies. If you don’t pin them down, they fly away” it says at the top, Well try opening your mind because your mind is closed. The world was flat before it was round.

    • November 21, 2012 10:46 pm

      Firstly, thank you for taking time to read my blog.
      Secondly, though I admit I was being polemical, please do not assume that I am being close-minded or arrogant. This opinion is by no means that of a world expert. I do not idly believe what senior doctors or medical journals tell me. I look for and examine the evidence, as I have been taught to do.
      I have seen the LCP employed, both as a student, and as the grandson to a dying grandmother. From these experiences, I believe the LCP to be a measured and compassionate approach. That is why the media tirade, led by the Daily Mail, incensed me so.
      I will agree with you, and the Daily Mail, that doctors have erred putting patients on the pathway without discussion with them or their families. I will happily admit that as a profession, we need to improve communication at the end of life. The current state is, as I suggest, due in part our professional and societal fear of death. However, that problem is not specific or intrinsic to the LCP.

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