Healthcare Models

I. Healthcare Models

If you go to the USA a lot of the people there are unhappy with the state of their healthcare system.  They feel that it’s too expensive, that they pay way more than any other country in terms of percentage of GDP compared to the rest of the world and yet there are tens of millions of people who don’t have any form of medical insurance.  “Let’s face it guys, we need a one payer system, because if you look at Canada and Europe their healthcare is so much more accessible with equally good health outcomes.”

If you go to Europe then you will meet a lot of people who say that we need to get rid of socialised medicine.  There are too many patients who see their doctors for no good reason, the public are wasting resources, the government is too inefficient, there’s too much bureaucracy…  “We need to go to the American model of multi-payer, private healthcare.”

How can there be such a paradox?  How can so many people belonging to different healthcare models all be so upset at the care they are receiving?  If this was a scientific experiment that you had set up in a lab, you would think that by now there would be a definitive “answer”.  We would have reached a conclusion that says that one type of healthcare is certainly better than the other.

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Being A Doctor, What It Means, What It Doesn’t Mean, What It Will Mean


I’d say that one of the main things that made me choose to become a doctor was that I felt like I had a kind of natural ability and affinity for the subject.  It’s likely that this was a completely false assumption however.  It stemmed from growing up in a highly medical background, where a lot of family and friends were involved in the field.  As a result I easily identified with the profession.  I assumed and it was presumed by many others that I would become a doctor as if it was somehow in my DNA (at this point it’s hard to say what came first.  My desire to become a doctor or the fact that everyone around me was saying that I would become a doctor.  A kind of chicken and egg scenario).

I recall when I was being taught Biology in Primary School for example and the other kids looking expectantly, as if somehow I already knew all the answers.  This continued on throughout high school.  There was one time when we were briefly being taught about electrocardiograms and for some reason the other people in the class and also the teacher started to ask me questions about how to interpret them.  This low-level reinforcement over many years is likely to have shaped my opinion on medicine and my own identity as a doctor.

When I began medical school it was really just a continuation of school.  The only thing that seemed to change from school was the fact that on top of going to a building to learn some random stuff everyday, when I got home my bed hadn’t been made and I had no food to eat.  The first three years did not involve seeing patients at all.  The theory went that medical students should have a baseline knowledge of this thing called “medicine” before we were even allowed to see an actual patient.  At this point in medical school if one of the medical students had seen a patient, it was almost like a yeti sighting.  “You saw a patient?”  “Where did you see this patient?” “Well, I kind of saw the patient as he was running off into the woods”.

I remember having conversations with my family out of sheer frustration.  Why do I have to learn all this random stuff before I can even see a patient?  I just want to be a doctor!  Why do I have to learn all this stuff which will never be needed?  My parents and my elder brother would reassure me from time to time.  The most logical answer they were able to provide was something along the lines of earning your stripes, or that it would all add up to making a good doctor or something like that.

Just to give you an idea, here is a (shortened) list of subjects which we had to study before we could even see a patient.  All of these had an exam at the end of the course, or you wouldn’t be allowed to progress further in the course:

  • Anatomy
  • Histology
  • Nursing
  • Human Studies
  • Biophysics
  • Biochemistry
  • Embryology
  • Developmental Biology
  • Physiology
  • Pathology
  • Pathophysiology
  • Ethics
  • Latin
  • Heath Information Technology
  • Forensics
  • Medical Biology
  • Microbiology
  • Immunology

There’s eighteen subjects in the above list.  So that’s at least eighteen major exams we had to pass to finally move on to clinical medicine and see patients.

Clearly, going to medical school was not what I had expected it to be.  However, even though I was really frustrated in those first few years in terms of not being able to see patients, I’d be lying if I didn’t kind of enjoy learning such a vast array of interesting subjects.  And because it was just like school again i.e. memorising a large amount of random stuff, I was doing quite well at the work.

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Meaning & Purpose

I often wonder about what I am here for and what I’m meant to be doing with my short time on Earth.  It seems to be one of those things that everyone ponders from time to time, before giving up and then returning to their usual lives.  I don’t know why, but I’m always thinking of what I should be doing with my life and why.  I certainly seem to think about it more than anyone else I know.  It just seems shocking that life is so finite and how little time we have to do something that really matters.

Some people seem to be born with meaning.  We hear stories all the time about how someone started to play an instrument at age three, or had their first business at age 8 and sold it for a million dollars.  I am not one of these people.  My life has been a mish mash of random interests and as a child I was very curious about a large number of subjects.  I remember when I was in high school I was setting up an import export company, which ended up being illegal so I had to stop that.  I loved (and still love) playing the guitar and composing.  I don’t think there has ever been an age where I didn’t want to be a doctor.  I remember travelling to Bangladesh a lot as a child and thinking that I would like to devote my life to humanitarian endeavors.  These are just a few of the things that I have been interested in.  Everyone I meet has a similar list of subjects that have piqued their interest in the past, but which they aren’t actively pursuing.

The stories we tell ourselves and the stories that are told to us with regards to uber-successful people don’t seem legitimate or right.  The human condition demands curiosity from a young age.  Indeed, if we weren’t such avid learners we probably wouldn’t make it to adulthood.

Let’s take Mark Zuckerberg as a case study here.  He has one of those classic stories that gets told a lot.  It makes it sound like it’s all due to destiny.  The story goes like this; “Mark was a computer genius from a young age, coded as a child, went to Harvard and created a multi billion dollar company”.  The part that people miss telling is that Mark was studying Psychology as his major.  How is that possible?  Could it be that Mark Zuckerberg is also human and has an interest in a wide variety of subjects?  I am sure that if Zuckerberg became really successful in Psychology the story would read more like this all of a sudden; “Very insightful young boy, academically excellent, always had an interest in social interactions, went to Harvard, became one of the worlds leading psychologists.”

The word “synecdoche” springs to mind.  We take a small part of something and presume that this is the whole.  People aren’t two dimensional creatures.  We are complex beings in a complex world.

It seems to me that this attitude of having everything in our lives point towards a single direction is not a human way of living life.  Often we end up thinking of questions like “what am I meant to be doing with my life?” as if to say that there is a single thing that we should be doing to give us meaning and purpose.

It is my belief that this way of thinking has been largely implanted in our minds by society.  Society referring mainly to the education system but, this belief system is also perpetuated by our friends, family, work colleagues and so on.

If we take a look back through history, it strikes me that “jobs”as we know them today have only been around for two hundred years or so.  Before this time we lived in a much more human way.  When “jobs” arrived, which originally entailed working in factories we created an education system to meet the needs of industrialism.  It was a way of training people so that they could take up these new posts which had been created.  As time went on the jobs became more complex and people required more education and training.  Now all of a sudden you have to have a CV which makes it look like your life has all lead to this one moment in time.

Looking at my own CV, there’s so much that is missing in there.  Those pieces of paper do not represent me as a whole.  However, it makes it look like my whole life has all been leading smoothly to where I now am.  It essentially looks like this:  School —> High School —> Scholarship —> Medical School —> Scholarship —> Doctor.  This is a perfect CV for people who want a job, but I can guarantee that it won’t give you meaning and purpose.

If we take a look even further back in time and look at the great thinkers of the past such as Aristotle and Plato, all of a sudden we find people who have a wide variety of interests.  For their time they were masters in philosophy, science, literature, logic, ethics, aesthetics etc.  The way that the greats in history approached life is in my opinion the most human way of living life.

Letting our natural curiosity lead us, which is an absolutely normal human urge is probably the most authentic way we can live.  It doesn’t make sense to me how when we ask ourselves “what should I be doing with my life”, that we try and fill this void with one magical thing.  It is likely a combination of curiosities that we have to explore and learn from.  This also entails overcoming a lot of fear and a reluctance to settle for what we are comfortable with already.

I suppose I could summarise this essay quite succinctly:  A well lived life is a life full of curiosity, continuous exploration and learning.  Or as Henry Ford famously said: “Anyone who stops learning is old, whether at twenty or eighty. Anyone who keeps learning stays young. The greatest thing in life is to keep your mind young.”

NHS Startup Part XI – Cultivating Criticism

I am receiving more and more feedback about my service.  Both from patients and the NHS staff using my service.

Today was the first time that I had the full backing of the NHS employees using my service.  Before today, I have just felt like a crazy outsider trying to do something ridiculous.  Now that there is momentum all of a sudden it feels like people are queuing up to tell me their thoughts and insights.

NHS staff, in my opinion are treated very poorly.  It is not the type of organisation you should work for if you are a smart creative.  People are told that they should whistle blow in the NHS, be open and be honest, but when they do they end up being persecuted.  This results in a culture of employees keeping their head down, doing their job and trying to stay out of trouble.

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Incidental Finding

I’ve always thought the term “incidental finding” was strange.

“Incidental finding” is something doctors say when they look for one thing but then find something completely unrelated to what they were originally looking for.  For example if you have a chest x-ray looking for an infection, but instead we find a large shadow which may be cancer, we call this an “incidental finding”.

Like many things in the world of medicine we use fancy terms to describe things.  A GP friend of mine told me how he once saw a patient who came in with an itchy bottom.  My GP friend then diagnosed the patient with “pruritus ani”.  The patient turned around and said; “That’s clever, you just took what I said and said it in Latin!”.

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The Paradox Of Choice

Having a choice when starting a business seems to be a massive distraction and one of the major pitfalls a CEO could face.

I find it really interesting that a lot of famous startup incubators tend to give founders around $20,000 to execute their idea.  Some of the most successful startups in the world have become billion dollar businesses with this tiny amount of money.  I say it’s a tiny amount as a lot of people have access to this kind of money if they re-mortgage their house or take out credit card loans etc.  It’s not an unfathomable amount.

There are a number of reasons that this is such a good methodology.  When starting a project you should be aiming to tackle a specific problem.  The strategy should be to solve a problem which is super specific and that you think you can solve much better than any other service out there.  If you really have gone after a small niche then this amount of money should be all that you need to test your hypothesis*.

The other reason having limited funds is a good thing is because it limits your options.

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