Editorial

In 1518 Henry VIII granted a charter to a small group of London ‘physicians’ giving them the right to decide who could practise medicine. The deal was made on the condition that they would dedicate themselves to the health and security of the nation. At the birth of the National Health Service 430 years later in 1948, doctors’ duty to serve the people, and the state’s responsibility to support them, reached its highest point.

Faith, so the dictionary tells us, is confidence or trust in a person, a thing, or a concept. In the context of religion, it applies to a particular system of belief. If, then, as Nigel Lawson once asserted, ‘the NHS is the closest thing the English people have to a religion’ , a loss of faith in medicine, in doctors and in the NHS itself would be a very deep loss indeed. Lancet editor Richard Horton named it in 2017 when he wrote, ‘It is with exquisite sadness that anyone concerned with the future of health care in England now observes the present broken covenant of trust between government and medical profession’ .

Of course the personal–social contract that drives medicine along pre-dates the physician’s Tudor dealings. Two thousand years after Hippocrates, with medicine hurtling along its technical and rational trajectory, there still beats an ethic of service at its heart. And, though doctors aren’t prone to bandying the L-word around, most would agree that altruism – which reflects what was known in ancient Greece as caritas: the love of humanity – is medicine’s fundamental value.

Clinical work can be mentally and emotionally demanding and in my resilience projects I meet GPs and hospital doctors – from foundation year to senior consultant level – who are feeling the strain of working in an overstretched and under-resourced NHS. They are a pretty hardy bunch who in general have learned to cope by keeping emotions under wraps. They don’t moan and are normally reluctant to share stories of defeat or failure. Lately, however, they more often speak about the frustration they feel at being unable to look after patients to the best of their ability. Sometimes I have been struck by the undercurrents of loss that I sense in my resilience workshops: something like Richard Horton’s ‘exquisite sadness’ .

David Peters

Editor-in-Chief

The NHS depends on its highly (and expensively) trained doctors and nurses, but burnout and early retirement are on the rise in a system that’s failing to resource and support them (Wilson and Simpkin, 2019). The consequent feelings of ineffectiveness are an early feature of burnout. Doctors often blame themselves for feeling this way, so when the going gets tough, they try even harder to deliver: for a while they run on hope. I’m seeing signs that their hope is running out. Many are dropping out, but other equally dedicated souls struggle on because of their love for the work until, if the emotional and interpersonal strains are unremitting, exhaustion hits, and withdrawal and cynicism follow, for though doctors and nurses might brush the idea off, faith, hope and love provide a moral and ethical compass for their work. Without them we are lost.

This issue of JHH is all about keeping these values alive, and what gets in the way when, as Iona Heath tells us in her leading article, society is straitjacketing its professionals. We will learn that kindness is helping to build compassionate communities in urban Birmingham and rural Keynsham, and that healthworker resilience requires self-compassion. We hear about the power of hope from colleagues encouraging lifestyle change, who support people living with a cancer diagnosis, or work in end-of-life care. Chris Johnstone considers how we maintain hope in times of wider environmental unravelling. Hina J Shahid tells of faith discrimination in the NHS. So much of what we deeply value is intangible: no pharmaceutical can provide the faith, hope or love to help carry us through the unbearable times in our life. Yet every medicine is curiously entangled with how we feel about its prescriber. We may dismiss it as the placebo effect, but what if we were to more deliberately imbue a prescription with hope and care? David Zigmond reveals some inspiring possibilities. Finally, two future doctors consider medical schools’ duty of care and the future of medicine

References

Wilson H, Simpkin A (2019) Why are so many doctors quitting the NHS? – it’s time to ask the right questions. Thebmjopinion. Available at: https://blogs.bmj.com/bmj/2019/01/25/why-are-so-manydoctors-quitting-the-nhs-its-time-to-ask-the-right-questions (accessed 19 June 2019). Horton R (2017) Tackling the despair of England’s NHS. The Lancet 389 (10066) p238.