Richard Smith on doing the right thing – but at a snail’s pace

Richard SmithOne of the things about being an “old guy” is that you realise how extraordinarily slow we are at doing the right thing. You also see wheels being constantly reinvented.

This morning, for example, I heard on the radio how the Health Select Committee had “discovered” that 10% of people suffer harm on being admitted to hospital. The chairman of the committee was shocked and thought that the NHS wasn’t doing enough.

My mind drifted back to 1990 when I first “discovered” that medical errors were common and wrote about it in an editorial in the BMJ. Like the committee of today, I recommended that Britain conduct a systematic study of errors as had been done in New York in the 80s and California in the 70s. We’ve still not had a study of the required scale, although a smaller study has confirmed that errors are common in Britain as they are in all health services.

Rereading my editorial of 1990 I see that it placed far too much emphasis on malpractice. That was the “over-riding narrative” of the time. Now it’s “targets.”

Meeting the “climate change czar” of the NHS last week I also thought back on my “discovery” of climate change (or climatic change, as we called it then) in 1993. In 1994 I portentously wrote: “Action is needed because of the high probability of serious harm to health.” I was, of course, catching on decades after climatologists, but despite positive signs the problem is still not being taken as seriously as it deserves.

There are other things that I’m sure must happen but where progress is depressingly slow. Despite the current fight back by publishers in the US, open access publishing will surely become the norm. I raved on about this to publishers at the Frankfurt book fair in the early 90s. Assisted suicide will also be legalised eventually in Britain, and the polypill, which was patented in 1999, may not be in all our mouths for another five years—but it will come.

Winston Churchill famously said of Americans: “You can always rely on the Americans to do the right thing…after they have exhausted every other possibility.” That is perhaps true of all of us.