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The last few weeks reading material has been a bit of a crazy juxta posed bag of opposites.

If you follow these blogs or you read them regularly, you will know that I have been on the artificial intelligence and algorithm thing for a while, thanks to Harari’s books – Homo deus and 21 lessons.

It took 21 lessons to finish when I went on holiday last week but got distracted into, This is going to hurt by Adam Kay.

I was never going to read that book, because I felt that it would be sensationalised nonsense, overdone to try and be funny and totally at odds with the stuff that I’ve written, that I have read from other people in the same sphere, particularly, Do no harm by Henry Marsh.

Do no harm is an extraordinary book that I have written about before in these pages, when a neurosurgeon (retired) talks honestly about cases that he'd worked on and the issues associated with them.

But, This is going to hurt, is an entirely different, all together and I am surprised it took me so long to get to it.

For several weeks I have been immersed in, where the future is going and how extraordinary health care will be (for those that can afford it) in the coming decades.

I have even by chance, met someone very senior, in one of the most disruptive healthcare companies in the world and had conversations with them about these subjects.

Then I dropped back to Adam Kay and actually what it is like on the front line.

A couple of notes, here though to remember before considering the Adam Kay stuff:

1. His clinical experience stops at 2010, so the arguments will be that things are different 9 years further on (I don’t believe they are).
2. My experience in the same world as Adam Kay’s stopped in 1997 and therefore, I would be told my comments would be inappropriate and out of touch, (I don’t think they are).

In a world where the development of technology and science is moving so fast, that the possibilities of treatment are almost limitless, we appear to have forgotten, one significant factor.

Health care is delivered by humans, for humans (at least for the moment) and the demand for the treatment outstrips the capacity for human beings providing it.

If you were to read, This it is going to hurt, as an 18 year old considering going into medical school, it would be hard to justify your decision to do that.

You might feel that it would be “different for you” but it will be hard to see how that could be the case.

When I worked in the hospital service, between 1994 and 1997 as a “Junior”, it was pretty much exactly as described in Adam Kays book.

Well, time might have fogged my memory, I am pretty sure It is relatively accurate to describe the three weeks running up to Christmas in 1995 as a maxilla facial SHO in Nottingham.

We should have had 5 SHO’s in the department to do a 1 in 4 on-call rota, with one person to cover and we had two (and one was off  sick or off for 3 weeks), I did 100 hours in one week and 120 the next and then 110 the following week. This culminated into a bit of a personal disaster for me, because I had also been asked to present a case at the regional maxilla facial trainee study day in the third week of that hellish schedule.

I did present the case and it was horrendous, I could hardly remember my name or stand up to be honest, let alone provide a reasonable presentation of something I knew nothing about in any event.

After the presentation I was taken aside by one of my consultants and told that I was a disgrace to the department, and I had let them down in front of the region.

A few days later, the same consultant stood me up in the middle of the coffee room with about 50 people in it and screamed at me for several minutes, after I had (allegedly) admitted a patient to the ward for surgery, without going through the "proper administrative procedure."

I had never even seen the patient before.

At the Christmas night out, (the same night) two of the other consultants came to me and told me not to worry about it and that they appreciated how much I had done over the past few weeks.

It seemed like a quite cold comfort after the mornings that I had been sat in the bath in my doctor’s residence crying before I went to work.

I had kind of made the mistake of thinking that things had moved on and changed since then, but they haven't by 2010 and I don’t believe they have now.

We’re going to have a gap and a massive gap, between here and there.

Sure, in a few years time, the NHS will have an artificial intelligence triage, where you can speak to a computer and it will tell you that you are able to see a nurse instead of another doctor.

But that suggests that nurses will be available.

The online GP will be able to tell you that you should now go and have a procedure carried out by this type of surgeon or that type of surgeon.

But that opposes that somebody has decided to put in the effort and to take all the s**t to train to be a surgeon in the first place.

This doesn’t even take into account everybody who reports everything you see in a hospital medically, including Lab Technicians, Porters, Sonographer’s and everybody else who provides this treatment.

The trouble is, the Police will tell you it’s the same - Under resourced.

The teachers, the same - Under resourced.

The only people that don't seem to be under resourced are the guys who work in the banks and the lawyers that support the banks.

Adam Kay’s book is one of the funniest I have read, perhaps ever, also one of the saddest.

I have written long and hard here about what it is like when you’re criticised when something goes wrong and how the culture of blame that we’ve allowed to develop in this country is provoking and promoting a culture of defensive practice in medicine, which is unsustainable.

I can only see it directly from the eyes of a minor oral surgeon, who works in primary care.

The weight must be 1000x heavier for someone who works in “proper surgery”, we will reach a point, I believe, in the not too distant future, there’s some huge and difficult choices to be made, to re-design a system that allows us to support, develop and remunerate our people who work in the essential services, as much as the people who develop the new technology.

There is a miss match here and it is unsustainable.

Blog Post Number - 2107