But I think the real progress has been in the little things, and I think that this is lots of little things that we might do better at.
Have accumulated in better care and with more. With that comes increased complexity and more risk of of things going wrong.
Uh, I think that's. The psychological pressures and everything else is in great danger of producing a risk averse behaviour,
which in the end I think may not be that good for everybody.
Oh, yeah. I think that the trouble is you're never criticised for doing things that potentially are more harmful.
And they said you will never be criticised for admitting a patient to hospital.
You'll never be criticised for keeping them in an extra couple of days.
But if you send them home early or don't admit them, but ask them to hospital, keep them and expose them to a lot of risk.
So I think that that a lot of this litigiousness, immigration, aggressive behaviour we've got,
um, may result in more risk averse behaviour, which may have indirect bad effects.
I think doctors are paid to make those clinical judgements and clinical judgements and an assessment of risk.
Yeah, and I know neither decision is ever a risk free, but if you try and make the one that's always risk free,
that's often to do the wrong thing and treatment plans are there or not.
Yeah. And what happens if you don't fill? Well, that's where they were.
I mean, I said, well, I think that's very interesting because.
We talk on the one hand about individualised treatment plans for individual people and personalised medicine,
and on the other hand, we have just a tsunami of guidelines that whether the guidelines are,
you know, their only guidelines well,
they're only guidelines until you don't follow them and he goes wrong and then you find out something quite different.
Uh, guidelines, if you don't follow them, it all goes well. And every worries about that.
And I think the, um. But that's fine.
That's not the kind of the general medical sphere where things are clear.
But when you look at things like cancer, chemotherapy and radiotherapy, you've got treatments that are effective.
But at the moment you end up with very toxic treatments and then guidelines.
If you if you don't follow the guidelines in those spheres,
I think life can be very difficult because things can go wrong because the drugs are pretty toxic.
And the guideline is that you're not getting a lot of benefit.
But I think in the kind of the complex multisystem diseases that I kind of deal with, I think there is still a bit more freedom for judgement.
I how you might you might go back to it. But I think we do need to kind of think about the rigid guidelines, personalised medicine.
How does it all work? Uh. Particularly with the amount of this stuff that's around, the pressures on newly qualified dogs is huge and it's much,
much easier to pull a guideline off the shelf than to think through the problem.
And I think that's perhaps the biggest change is that, yeah, I think we all, before this became the norm,
had our own guidelines that we developed and thought through either from experience, colleagues, original reading.
It worked out how to do things that's kind of now being taken away from the individual dog and it's being done by committees.
But I think losing the skill to work out how you do it is perhaps not a good thing.
And I think that is anxiety provoking. And I just wonder whether dogs will be able to balance in my field.
You may have three guidelines, conflicting.
How do you work and what's the right thing for the patient? I think the skill to do that requires.
Time, experience, but a willingness to take on the challenge.
How have you written much books, papers now that I to after people?
Very good. Where do you think nowadays you start more new treatments or stuff for patients?
Yeah. Oh, I made a career out of stopping at the stop and treatments that my colleagues started.
Yeah, yeah.
I mean, yeah, I think we spend, I spend more time rationalising treatment and because again it's part of the it's become increasingly difficult.
And when I first hear the idea of polypharmacy, we all understand that's a problem.
But when you look at things in terms the variety of drugs,
they're not because you've got vascular disease, you know, not because you've got respiratory disease.
And there's no obvious place to kind of say, well, you don't need that.
What I say is actually the benefit of this in your current situation is likely to be marginal and actually take you all the time.
So it is it's become increasingly difficult now.
I mean, my my academic career and public, I've I've actually, to be fair, but it's not a huge public plan period for either candidate.
So what I have managed to do over many years is to help and support trainee's, get things published in abstracts, published and posters.
So I've got my name on quite a large number of posters which have supported junior doctors,
because one of my big bugbears is that the average new I think one of the other big problems to the
profession lies around the lack of statistical and numerical skills in the medical profession.
Mm hmm. Um, which for a profession that is largely built on a probability of disease, X or Y,
and whose treatments rely heavily on the results of statistical analysis of trials, the lack of numerical skill in the profession is one thing.
And I actually kind of get quite interested in maths and statistics and spend time with the trainee.
Just pointing out that if you need to think about the analysis before you collect the data and just simple steps, I mean, um.
And so I've got I've got a background in statistics, so.
And doing that is quite helpful, but I am disappointed in me, the lack of appreciation of that being newly qualified doctors go.
What was your thesis on race between, you know, my my um,
my Ph.D. thesis in London was on autoimmunity and the homo right with Bloom is deeply part of it.
Yes. And, um, and Deborah Doleac I so it's a kind of an interesting, interesting mixed area.
Nobody could work out whether it was the chronology, gastroenterology or what, but that was where I did my original empty.
Well that's a lovely and really thank you very much indeed. I think we ought to stop that right now.
And many, many things that I've got is.