Change, we have to

Abstract

In my 50th year in the profession, it has become almost an expectation among my young colleagues that I should hark back frequently to the ‘good old days’, but it would be churlish to do so as there has been so much ‘change for the good’. However there is a fundamental change that has happened quite surreptitiously but threatens to bankrupt healthcare systems, at least in Britain and Australia. It is what I have called the ‘millefeuille’ pnenomenon (millefeuille – a rich confection of thin layers of puff pastry and a filling of jam, cream, etc. – Shorter Oxford Dictionary on historical principles. Sixth edition). The thin ‘vanilla slice’ of my childhood is now quite unmanageable in its transformed existence. Between the substance of the top (funding) layer and the bottom (healthcare ‘coal face’) layer there is an ever-burgeoning layer, upon which one cannot get a grip, that is absorbing money, like a sponge, leaving the bottom layer dry and poor. The more that is poured into the top, the more is soaked up in a conglomerate that acts with a kind of ‘Brownian motion’ often with the only apparent purpose of sustaining itself. I believe the only possible solution, so far offered, was by Douglas Adams in The Hitchhikers Guide to the Galaxy, or perhaps the sequel, The Restaurant at the End of the Universe, when the entire ‘management layer’ of this planet was decanted onto another small and distant planet out in space. Perhaps the current ‘recession’ might start to ration this layer, which is, of course, not the sole prerogative of the healthcare sector. However I fear it will continue to thrive as more and more ‘accountability’ and ‘measuring’ initiatives flood into the system. Our students, now moving from ‘people-based’ learning to ‘problem-based’ learning, no longer need to know how the body ‘functions and disfunctions’. With the ability to key in the problem and have immediate access to the solution, there is no longer the need to ask ‘why’ and ‘how’, and eventually there is a strong risk that they will just be progressively replaced, or blend into the amorphous ballooning filling of the ‘millefeuille’.