I've been thinking about current medical care in the NHS. This was prompted by the good but extremely irritating and smug book "Do No Harm, Tales of Life, Death and Brain Surgery" by Henry Marsh (http://www.amazon.co.uk/Do-No-Harm-Stories-Surgery/dp/0297869876), a recently retired and exceptionally eccentric neurosurgeon, who worked at St Georges.
During his case presentations/anecdotes (classic medical fodder) he reveals his inner torment at the current state of medical practice in the NHS and how it impinges on what he wants to do. Now there is significant insight as he does portray his errors at length. However, he is exceptionally critical of others and himself, to the point of disservice. His main ire is of course aimed at the bureaucrats and managers, who get in the way of his service. He complains about the nanny state and training, and the inconceivable lack of clinical input into the construction and development of hospitals and care pathways.
What he fails to explain or to accept is that it is actually his role as the senior to look after these aspects. He is the senior after all. Who else has the expertise and the experience to help guide? Maybe he did but did not feel he was of use… He bemoans training, but refuses to have trainees or students in his clinic rooms. He bemoans the lack of beds, but all his patients were admitted the night before - this is highly unusual nowadays. Is it beneficial? Perhaps, perhaps not, but there is not the bed capacity to support this routinely, especially not in a tertiary referral unit which is always full. Of course if there were medications required pre-op then it's understandable, but maybe work should look into the rationale. He bemoans the encroachment of managers into his kingdom, but it is his antipathy to engage that is the cause.
Fundamentally, his regrets are common - mistakes made, both clinically and in life. However, sadly this book does not cover how he has changed or grown to improve. He enters as he leaves and there is no idea of how he affected his trainees, which is sad.