What will medicine look like in 20 years?

[Eccentric]

I don't think you're entirely correct in your assumptions.
I've been a doctor for 21 years and we thought we'd be facing quite a lot of those changes and it hasn't really happened. Robotic surgery was definitely coming in as I left hospital medicine and it's more prevalent now - but requires a skilled surgeon to operate it. Cancer survival is improving but the diagnosis and management of the aftermath is still difficult. People are living longer, cancer is going to be a very common cause of death for many more decades. We're not going to beat every cancer.
I think Amber's post is perfect about the realities of medicine right now - no need to repeat any of that. The reality is that 50% of UK graduates will go into general practice. The reality is also that GPs are haemorrhaging from the profession at an alarming rate (one leaves every 3 hours. Many are retiring early. Some are moving into public health and inform us with astonishment that they have time to eat and go to the bathroom in their day. Many are going to Australia, NZ or the new favourite Canada). Some of the se.x.ier specialties have a 1:8 or higher application rate. Many people never make it in their preferred specialty; still more change their minds. To go into medicine with the mindset of "I want to be a ...." is a risky thing because most people don't really know their skill sets at 18. You have to go in with the "I want to be a doctor and I really can't imagine doing anything wise with my life" attitude, in my opinion.
Things that have increased over the last 20 years and are set to get greater over the next 20 in my opinion?
1) Litigation. No win no fee lawyers are the bane of our lives. We get attempts to sue us fairly regularly. They are all absolutely hopeless cases but all take time (lots of time) and stress. Also it is really hard to have to keep seeing the patient who is suing you bit apparently remains happy to keep coming to see you regularly?
2) Entitlement. The "this is my third cold in three months and something needs to be done about it" attitude. The "my sore throat started this morning and I need it to be gone because I've got a party tomorrow" attitude. The "I need the NHS to deal with this because I paid my taxes" attitude.
3) Complaints. Lower level than the litigation stuff. Trekking more time. Getting worse across hospitals and primary care.
4) Older iller people living longer needing more support with no good social service input because I can't see that improving either with families ringing constantly, desperate for help that doctors have no role in providing but "who else is there?"
5) Mental health provision is already woeful. It's getting worse. We're expected to plug that gap somehow but really can't. It's going to be a big big problem going forward.
I could go on but I might have already won the award for the longest ever post.
I would suggest some reading for your daughter , Eccentric. 1) "This is going to Hurt" by Adam Kay - very true to life story of his junior years. Every young doctor I know has read it and says that if you still want to do medicine after that then it's the right job for you. 2) the two books by Henry Marsh - he's a neurosurgeon (and you don't get se.x.ier jobs than that in medicine) "Do No Harm" and "Admissions" (he's a bit of a pretentious tw*t but he writes well and manages to get across some of the changes to the NHS that led him to retire). It would be interesting to see her views after reading those.
Please don't anyone think that I am putting everyone off medicine as a career. For many of us it has served us well and I still enjoy seeing patients most of the time. And I desperately want good young doctors to come through and take some of the empty jobs! But it is definitely not glamorous and getting less so. There is very little respect from patients and that is also getting less so. I had an apparently educated lawyer screaming at me (and I use the word advisedly) for 10 minutes that she would sue me and I would lose everything because I refused to do what she wanted (I was right, she was wrong) - just in the last month.
If your dd goes for it, buy her the "My medical degree is worth more than your Google search" mug as a graduation present - she'll need it

Thank you for this. It is all really helpful! She has read Henry marsh.s book and it is partially to blame for her obsession with neurosurgery. Henry Marsh is her current hero She found it very exciting. That and Greys Anatomy's Mc Dreamy. I will buy the other book you mention for her. A stint in A&E is definitely on the cards when she is old enough.
Hearing all of the above may help to inject a bit of reality. I don’t want to make up her mind for her, I just want her to see the world as it is/will be rather than in TV show terms. If she gets the grades, she still wants to do it in 3 years time and her processing speed issues don’t prevent then I will absolutely support her but in the mean time I want to do my best to flag up the less sexy sides and some alternatives.

[PerpetualStudent]

Anybody want to speculate on the long term effects of increasing antibiotic resistance?

BTW a big thank you to the medical professionals who put up with it all to keep helping us! I watched the BBC documentary on the history of the NHS and was very moved by the story of its first days and the huge number of people who were finally able to get medical help after years of trying to cope with terrible conditions they couldn't afford to treat. I'm sorry so many people now take it for granted.

I think on this a lot as our family has to call on the GPs and consultants for the nth time in the last few years. Although I have met a few doctors I will try to avoid in future the vast majority have been sympathetic, patient and willing to find the best solution rather than a quick fix to get us out the door.

[piggys]

I don't think you're entirely correct in your assumptions.
I've been a doctor for 21 years and we thought we'd be facing quite a lot of those changes and it hasn't really happened. Robotic surgery was definitely coming in as I left hospital medicine and it's more prevalent now - but requires a skilled surgeon to operate it. Cancer survival is improving but the diagnosis and management of the aftermath is still difficult. People are living longer, cancer is going to be a very common cause of death for many more decades. We're not going to beat every cancer.
I think Amber's post is perfect about the realities of medicine right now - no need to repeat any of that. The reality is that 50% of UK graduates will go into general practice. The reality is also that GPs are haemorrhaging from the profession at an alarming rate (one leaves every 3 hours. Many are retiring early. Some are moving into public health and inform us with astonishment that they have time to eat and go to the bathroom in their day. Many are going to Australia, NZ or the new favourite Canada). Some of the se.x.ier specialties have a 1:8 or higher application rate. Many people never make it in their preferred specialty; still more change their minds. To go into medicine with the mindset of "I want to be a ...." is a risky thing because most people don't really know their skill sets at 18. You have to go in with the "I want to be a doctor and I really can't imagine doing anything wise with my life" attitude, in my opinion.
Things that have increased over the last 20 years and are set to get greater over the next 20 in my opinion?
1) Litigation. No win no fee lawyers are the bane of our lives. We get attempts to sue us fairly regularly. They are all absolutely hopeless cases but all take time (lots of time) and stress. Also it is really hard to have to keep seeing the patient who is suing you bit apparently remains happy to keep coming to see you regularly?
2) Entitlement. The "this is my third cold in three months and something needs to be done about it" attitude. The "my sore throat started this morning and I need it to be gone because I've got a party tomorrow" attitude. The "I need the NHS to deal with this because I paid my taxes" attitude.
3) Complaints. Lower level than the litigation stuff. Trekking more time. Getting worse across hospitals and primary care.
4) Older iller people living longer needing more support with no good social service input because I can't see that improving either with families ringing constantly, desperate for help that doctors have no role in providing but "who else is there?"
5) Mental health provision is already woeful. It's getting worse. We're expected to plug that gap somehow but really can't. It's going to be a big big problem going forward.
I could go on but I might have already won the award for the longest ever post.
I would suggest some reading for your daughter , Eccentric. 1) "This is going to Hurt" by Adam Kay - very true to life story of his junior years. Every young doctor I know has read it and says that if you still want to do medicine after that then it's the right job for you. 2) the two books by Henry Marsh - he's a neurosurgeon (and you don't get se.x.ier jobs than that in medicine) "Do No Harm" and "Admissions" (he's a bit of a pretentious tw*t but he writes well and manages to get across some of the changes to the NHS that led him to retire). It would be interesting to see her views after reading those.
Please don't anyone think that I am putting everyone off medicine as a career. For many of us it has served us well and I still enjoy seeing patients most of the time. And I desperately want good young doctors to come through and take some of the empty jobs! But it is definitely not glamorous and getting less so. There is very little respect from patients and that is also getting less so. I had an apparently educated lawyer screaming at me (and I use the word advisedly) for 10 minutes that she would sue me and I would lose everything because I refused to do what she wanted (I was right, she was wrong) - just in the last month.
If your dd goes for it, buy her the "My medical degree is worth more than your Google search" mug as a graduation present - she'll need it

Completely fascinating and amazing post LoobyLou.

There are often very good articles and discussions about the NHS on the Guardian website. I recommend them to any youngster interested in a career in the NHS.

[kenyancowgirl]

I don't think you're entirely correct in your assumptions.
I've been a doctor for 21 years and we thought we'd be facing quite a lot of those changes and it hasn't really happened. Robotic surgery was definitely coming in as I left hospital medicine and it's more prevalent now - but requires a skilled surgeon to operate it. Cancer survival is improving but the diagnosis and management of the aftermath is still difficult. People are living longer, cancer is going to be a very common cause of death for many more decades. We're not going to beat every cancer.
I think Amber's post is perfect about the realities of medicine right now - no need to repeat any of that. The reality is that 50% of UK graduates will go into general practice. The reality is also that GPs are haemorrhaging from the profession at an alarming rate (one leaves every 3 hours. Many are retiring early. Some are moving into public health and inform us with astonishment that they have time to eat and go to the bathroom in their day. Many are going to Australia, NZ or the new favourite Canada). Some of the se.x.ier specialties have a 1:8 or higher application rate. Many people never make it in their preferred specialty; still more change their minds. To go into medicine with the mindset of "I want to be a ...." is a risky thing because most people don't really know their skill sets at 18. You have to go in with the "I want to be a doctor and I really can't imagine doing anything wise with my life" attitude, in my opinion.
Things that have increased over the last 20 years and are set to get greater over the next 20 in my opinion?
1) Litigation. No win no fee lawyers are the bane of our lives. We get attempts to sue us fairly regularly. They are all absolutely hopeless cases but all take time (lots of time) and stress. Also it is really hard to have to keep seeing the patient who is suing you bit apparently remains happy to keep coming to see you regularly?
2) Entitlement. The "this is my third cold in three months and something needs to be done about it" attitude. The "my sore throat started this morning and I need it to be gone because I've got a party tomorrow" attitude. The "I need the NHS to deal with this because I paid my taxes" attitude.
3) Complaints. Lower level than the litigation stuff. Trekking more time. Getting worse across hospitals and primary care.
4) Older iller people living longer needing more support with no good social service input because I can't see that improving either with families ringing constantly, desperate for help that doctors have no role in providing but "who else is there?"
5) Mental health provision is already woeful. It's getting worse. We're expected to plug that gap somehow but really can't. It's going to be a big big problem going forward.
I could go on but I might have already won the award for the longest ever post.
I would suggest some reading for your daughter , Eccentric. 1) "This is going to Hurt" by Adam Kay - very true to life story of his junior years. Every young doctor I know has read it and says that if you still want to do medicine after that then it's the right job for you. 2) the two books by Henry Marsh - he's a neurosurgeon (and you don't get se.x.ier jobs than that in medicine) "Do No Harm" and "Admissions" (he's a bit of a pretentious tw*t but he writes well and manages to get across some of the changes to the NHS that led him to retire). It would be interesting to see her views after reading those.
Please don't anyone think that I am putting everyone off medicine as a career. For many of us it has served us well and I still enjoy seeing patients most of the time. And I desperately want good young doctors to come through and take some of the empty jobs! But it is definitely not glamorous and getting less so. There is very little respect from patients and that is also getting less so. I had an apparently educated lawyer screaming at me (and I use the word advisedly) for 10 minutes that she would sue me and I would lose everything because I refused to do what she wanted (I was right, she was wrong) - just in the last month.
If your dd goes for it, buy her the "My medical degree is worth more than your Google search" mug as a graduation present - she'll need it

Thank you for this. It is all really helpful! She has read Henry marsh.s book and it is partially to blame for her obsession with neurosurgery. Henry Marsh is her current hero She found it very exciting. That and Greys Anatomy's Mc Dreamy. I will buy the other book you mention for her. A stint in A&E is definitely on the cards when she is old enough.
Hearing all of the above may help to inject a bit of reality. I don’t want to make up her mind for her, I just want her to see the world as it is/will be rather than in TV show terms. If she gets the grades, she still wants to do it in 3 years time and her processing speed issues don’t prevent then I will absolutely support her but in the mean time I want to do my best to flag up the less sexy sides and some alternatives.

Here’s a suggestion, Eccentric, instead of buying her the book, why not encourage her to seek out literature herself and borrow it? Most school libraries have the 3 books LL referred to and others that may interest her too - like Amber I am reading this as being very led by you - let her lead it if she is very interested - if she isn’t really, she won’t and might discover an alternative career that she prefers! My son is very keen on Medicine - he is always coming home with some book or another - I know that Do no harm was the first one he read and it inspired him to seek out others - not through me, though, and the only book we have purchased at his request, was for Christmas last year, a rather lovely old reference book with da Vinci style drawings of anatomy!!

[loobylou]

Some more thoughts about future changes...
I spoke to some friends today and the feeling was that probably there would be few major changes that will be noticeable on a population basis. Three were our thoughts...
In the last 20 years the way we treat heart attacks and strokes has changed completely but probably very few normal people are aware of those changes. There may be similar scenarios in the future but they are also unlikely to have enormous impact (except to the individuals).
I think medicine is likely to possibly become graduate entry or at least there will be more post-grad-only courses. I think someone will try this as a way to reduce the number of leavers.
There will be increasing privatisation, possibly complete privatisation within 20 years. As it is many areas of the NHS have been privatised without any fanfare. (An example, one of many: My friend's husband is a consultant microbiologist working for a hospital trust in the home counties. The lab service has been privatised. He is still employed by his trust, all the lab staff are employed by the private company. Their lab has been relocated to an industrial estate so he no longer even works at the hospital despite being a consultant and needing regular meetings with fellow doctors. He has to drive back and forth. He can't park at the hospital. Their terms and conditions are rubbish so staff are leaving/disgruntled. He has no say any more about anything. He was working as the only consultant (including on call every night and weekend) for 4 months till they managed to appoint another from overseas. They're still 1 down. The company have no interest in patient care except in so far as it affects statistics). If you have a pacemaker fitted now, you are very likely to have a private company's technician brought in to check it - a family member does this job. She is paid more than me (or the registrar doing the operation), is little more than half my age, has a company car and works around 20 hours a week for the American company who won't let their devices be used unless their staff are in the theatre. This is going to get more widespread and only the dregs that are impossible to make a profit from (palliative care, primary care, elderly care) will be left.
Finally we think that prevention, whilst it should be a bigger deal, will not be as big a change as all that. For example (and this is in the public domain so not confidential) about 3 years ago a diabetic patient had an amputation and then sued the GP practice for not informing him of how his condition could affect him. Despite being able to prove that they had invited him for diabetes review at least 3 times a year every year, the practice lost and the patient won because they did not "prove" that they had educated him well enough. Since then we send a letter every year to these patients warning them of the consequences of their lack of monitoring etc. Guess what the biggest complaints are now? Yes, that we've sent a "scary" letter that makes people uncomfortable and is not "respectful" enough. So prevention will definitely play a big role in doctors' lives but will definitely not get rid of the need for cures!
My biggest hope for the profession is that we are growing a new generation of angry feisty young doctors who will stand up to managers and NHSE and the DoH and say that they refuse to lie down and take things any more. Unfortunately many people who go into medicine are "good girls and boys" who are not natural rebels. I think this is changing. I am in lots of groups with people who want to see change.
Eccentric, get your daughter to Google and follow people like Chris Day and Jenny Vaughan and Moosa Qureshi who are doctors passionate about seeing justice done in their profession and passionate about helping doctors in the NHS. That will give her another but hopefully interesting perspective...

[Eccentric]

I don't think you're entirely correct in your assumptions.
I've been a doctor for 21 years and we thought we'd be facing quite a lot of those changes and it hasn't really happened. Robotic surgery was definitely coming in as I left hospital medicine and it's more prevalent now - but requires a skilled surgeon to operate it. Cancer survival is improving but the diagnosis and management of the aftermath is still difficult. People are living longer, cancer is going to be a very common cause of death for many more decades. We're not going to beat every cancer.
I think Amber's post is perfect about the realities of medicine right now - no need to repeat any of that. The reality is that 50% of UK graduates will go into general practice. The reality is also that GPs are haemorrhaging from the profession at an alarming rate (one leaves every 3 hours. Many are retiring early. Some are moving into public health and inform us with astonishment that they have time to eat and go to the bathroom in their day. Many are going to Australia, NZ or the new favourite Canada). Some of the se.x.ier specialties have a 1:8 or higher application rate. Many people never make it in their preferred specialty; still more change their minds. To go into medicine with the mindset of "I want to be a ...." is a risky thing because most people don't really know their skill sets at 18. You have to go in with the "I want to be a doctor and I really can't imagine doing anything wise with my life" attitude, in my opinion.
Things that have increased over the last 20 years and are set to get greater over the next 20 in my opinion?
1) Litigation. No win no fee lawyers are the bane of our lives. We get attempts to sue us fairly regularly. They are all absolutely hopeless cases but all take time (lots of time) and stress. Also it is really hard to have to keep seeing the patient who is suing you bit apparently remains happy to keep coming to see you regularly?
2) Entitlement. The "this is my third cold in three months and something needs to be done about it" attitude. The "my sore throat started this morning and I need it to be gone because I've got a party tomorrow" attitude. The "I need the NHS to deal with this because I paid my taxes" attitude.
3) Complaints. Lower level than the litigation stuff. Trekking more time. Getting worse across hospitals and primary care.
4) Older iller people living longer needing more support with no good social service input because I can't see that improving either with families ringing constantly, desperate for help that doctors have no role in providing but "who else is there?"
5) Mental health provision is already woeful. It's getting worse. We're expected to plug that gap somehow but really can't. It's going to be a big big problem going forward.
I could go on but I might have already won the award for the longest ever post.
I would suggest some reading for your daughter , Eccentric. 1) "This is going to Hurt" by Adam Kay - very true to life story of his junior years. Every young doctor I know has read it and says that if you still want to do medicine after that then it's the right job for you. 2) the two books by Henry Marsh - he's a neurosurgeon (and you don't get se.x.ier jobs than that in medicine) "Do No Harm" and "Admissions" (he's a bit of a pretentious tw*t but he writes well and manages to get across some of the changes to the NHS that led him to retire). It would be interesting to see her views after reading those.
Please don't anyone think that I am putting everyone off medicine as a career. For many of us it has served us well and I still enjoy seeing patients most of the time. And I desperately want good young doctors to come through and take some of the empty jobs! But it is definitely not glamorous and getting less so. There is very little respect from patients and that is also getting less so. I had an apparently educated lawyer screaming at me (and I use the word advisedly) for 10 minutes that she would sue me and I would lose everything because I refused to do what she wanted (I was right, she was wrong) - just in the last month.
If your dd goes for it, buy her the "My medical degree is worth more than your Google search" mug as a graduation present - she'll need it

Thank you for this. It is all really helpful! She has read Henry marsh.s book and it is partially to blame for her obsession with neurosurgery. Henry Marsh is her current hero She found it very exciting. That and Greys Anatomy's Mc Dreamy. I will buy the other book you mention for her. A stint in A&E is definitely on the cards when she is old enough.
Hearing all of the above may help to inject a bit of reality. I don’t want to make up her mind for her, I just want her to see the world as it is/will be rather than in TV show terms. If she gets the grades, she still wants to do it in 3 years time and her processing speed issues don’t prevent then I will absolutely support her but in the mean time I want to do my best to flag up the less sexy sides and some alternatives.

Here’s a suggestion, Eccentric, instead of buying her the book, why not encourage her to seek out literature herself and borrow it? Most school libraries have the 3 books LL referred to and others that may interest her too - like Amber I am reading this as being very led by you - let her lead it if she is very interested - if she isn’t really, she won’t and might discover an alternative career that she prefers! My son is very keen on Medicine - he is always coming home with some book or another - I know that Do no harm was the first one he read and it inspired him to seek out others - not through me, though, and the only book we have purchased at his request, was for Christmas last year, a rather lovely old reference book with da Vinci style drawings of anatomy!!

Thank you for your observations. My Dd does get books from the library and from second hand bookshops as well as from amazon used books. She spends hours ploughing through them and medicine has been her main source of reading material since she was about 9 Not because I have bought her books I haven’t. She got Henry marsh’s book from a charity shop. She has a giant book on anatomy and has taught herself the names of every body part. She watches videos on surgery that make me cringe. All she talks about is surgery. She says she doesn’t want children because it would distract her from her work. Just because I post for ideas on this forum it doesn’t mean that i lead my daughters in any direction in particular. I enjoy hearing others perspectives and value many of the posts. I have found this forum to be very helpful and informative. Not that I have to explain myself but what I am trying to do is lead my daughter away from obsession, to open her mind to their possibilities and to avoid disappointment should she not get the grades that she needs. I don’t wish to lead her into or out of any career but as I am sure you will agree having an open mind and being flexible in ones ambitions especially at 15 is a good idea.

[Amber]

Loobylou what a sobering post. I know two people who are accomplished, and in one case eminent, consultant surgeons in their fields (two different specialities) and who have both in the last two years resigned their NHS contracts because conditions became so awful. One works entirely privately now and the other divides his time between private work and charity work overseas. They got fed up with the managerialism, the bureaucracy and the erosion of their own autonomy; of being unable to operate because theatres were understaffed or beds were full or, in one case, when the Trust ran out of money and stopped all non-cancer operations for two weeks. Both of these people have many years' experience and are a massive loss to the NHS.

The issue of funding is not going to go away - my own view is that it is based on a lovely, idealistic but unsustainable model, but that no government is ever going to tackle it as it is like some kind of semi-religious icon now - Nye Bevan's ghost is mentioned if anyone ever suggests that keeping everything free at the point of delivery is not realistic and will result in systemic collapse. Doctors and other front line staff will be the ones shouldering this increasingly heavy burden; and there is only so far that a vocation and a humanitarian spirit can take you in the face of entirely unrealistic demands which threaten to undermine and destroy the whole project and leave it as the poorly-resourced fallback for the poor and disadvantaged, while the rest of us are forced into expensive private schemes. (Long sentence sorry!).

[loobylou]

I think you're right Amber. I think that "free at the point of use" or (as many of my friends refer to it, "free at the point of abuse") might not be sustainable going forward. But this needs a brave (ha!) government to say so and actually have a debate about what that could/should look like. At the moment US companies are becoming big investors and many of us are worried because the current government seems to favour a US style health service. There are much better examples of insurance based schemes in Europe (admittedly most of them with higher taxes than the US). Most of us know that, to stay honourable and do the right thing, in a US style health service (or a Polish/Romanian/Turkish) model is really difficult. That's why it needs to be carefully thought through and planned for, not sleep walked into.
This might sound like a conspiracy theory but most doctors I know truly believe that the government is deliberately trying to drive the NHS into the ground and wanting the doctors to throw their hands up and say "ok we give up, we can't do it any more" so they can say "we didn't want privatisation but those greedy doctors asked for it".
World Mental Health Day today - if you're a female doctor you're 4 times more likely to die by suicide than the national average. There are an average of 9 doctor suicides a month now in the UK which is a huge rise over the last few years. Food for thought.

[Amber]

I think you're right Amber. I think that "free at the point of use" or (as many of my friends refer to it, "free at the point of abuse") might not be sustainable going forward. But this needs a brave (ha!) government to say so and actually have a debate about what that could/should look like. At the moment US companies are becoming big investors and many of us are worried because the current government seems to favour a US style health service. There are much better examples of insurance based schemes in Europe (admittedly most of them with higher taxes than the US). Most of us know that, to stay honourable and do the right thing, in a US style health service (or a Polish/Romanian/Turkish) model is really difficult. That's why it needs to be carefully thought through and planned for, not sleep walked into.
This might sound like a conspiracy theory but most doctors I know truly believe that the government is deliberately trying to drive the NHS into the ground and wanting the doctors to throw their hands up and say "ok we give up, we can't do it any more" so they can say "we didn't want privatisation but those greedy doctors asked for it".
World Mental Health Day today - if you're a female doctor you're 4 times more likely to die by suicide than the national average. There are an average of 9 doctor suicides a month now in the UK which is a huge rise over the last few years. Food for thought.

I share your concerns. American corporations are creeping in and no one knows and so no one opposes it. My cousin just lost her job as a nurse because a US organisation took over the clinic she works in. You are right that some European countries have sustainable models of insurance/taxation funding for health care; but let's think - with things as they are, do you think we will follow a European or a US model? Zero hours contracts, loss of workers' rights, big profits, here we come! And sleep walk? Our honourable government? Looby, wash your mouth out - perish the very thought of it!

[stroudydad]

As someone who has a few health issues, I’ve been interested in this post.. and actually, now I am just sad...
LL can I ask how the treatment of HA/stroke have changed??