Medicine and social justice? plus ça change …

“Medicine is a social science, and politics is nothing else but medicine on a large scale. Medicine, as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution: the politician, the practical anthropologist, must find the means for their actual solution… The physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction.”

Rudolf Virchow 1848

“… it is useless to tell him that what he or his sick child needs is not medicine, but more leisure, better clothes, better food, and a better drained and ventilated house. It is kinder to give him a bottle of something … and tell him to come again … if it does not cure him. When you have done that over and over again every day for a week, how much scientific conscience have you left?”

Bernard Shaw. Preface to A Doctor’s Dilemma 1909

“The most common criticism made at present by older practitioners is that young graduates have been taught a great deal about the mechanism of disease, but very little about the practice of medicine—or, to put it more bluntly, they are too “scientific” and do not know how to take care of patients.”

Francis W. Peabody, The Care of the Patient. 1925

“… large sections of the population have no medical care at all or certainly not enough. The technology of medicine has outrun its sociology. Many health problems have been solved medically but remain socially untouched, thus defeating the progress and wasting the grians of medical science.”

Henry Sigerist 1941

“We have all been willing participants in allowing the creation of a myth, because it seems to serve our interests to believe that illness can be vanquished and death postponed until further notice. … inequalities, or iniquities, cannot be shrugged off, yet successive governments seem oblivious to them. The extent of the re-examination and reorientation of values called for is breathtaking. But so also is the extent of the human wastage and misery which we tolerate now with hardly a thought as to whether things might be otherwise …”

Ian Kennedy Reith Lectures 1980

“The current culture of medicine does not incorporate social issues as central to its practice; moreover, when such a perspective is incorporated into medical education or residency training, issues including health care disparities, culturally and linguistically accessible care, homelessness, poverty and immigration are usually afforded a one-hour lecture block at the end of a long day of physiology and pathology or situated in the middle of rigorous hospital-based clinical responsibilities. This not only reinforces a perception of social justice issues as an “add-on” to the central curriculum but also fails to engage trainees in effective ways.”

Sayatani Dasgupta: Medical Education for Social Justice: Paulo Freire Revisited 2006

“A strong case is made that the present content, organisation, and delivery of health professionals’ education have failed to serve the needs and interests of patients and populations. To take one example: there is a gross mismatch between the supply and demand of doctors and nurses, with massive shortfalls where health professionals are needed most.”

Richard Horton, A New Epoch for Health Professionals’ Education. The Lancet 2010

“There is a social gradient in health – the lower a person’s social position, the worse his or her health. Economic growth is not the most important measure of our country’s success. Action on health inequalities requires … the fair distribution of health, well-being and sustainability … “

The Marmot Review 2010

“I observe this again and again that I cannot address medical issues as I have to deal with the patient’s agenda first, which is getting money to feed and heat.”

General Practitioners at the deep end.  Glasgow University 2013

I am grateful for the first comment and link to Bastian Cole’s defence of a medical general practitioner  which resonates strongly with many, if not most GPs.

To clarify my position,

Whilst I strongly support the holistic practitioner whose practice is attentive to each patient’s narrative history and individual circumstances,

I strongly believe that the NHS – like every so-called-healthcare-service is called upon to cope with the consequences of political decisions that create inequalities and dis-empower people, that fails in a duty to provide adequate education, employment, housing and financial security and then blames people for their illnesses and berates them for being a burden on hospitals and GP surgeries.

The burden on the NHS – as I intended to highlight with the quotes above – is the failure of those in power to adequately share the benefits that power bestows and tackle the social determinants of health so that fewer people are dependent on the social and emotional support that the NHS is increasingly called upon to provide.

Further reading:

Medical Advocacy

A Perfect Storm: Welfare meets Healthcare