1 00:00:00,150 --> 00:00:12,880 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. 2 00:00:12,880 --> 00:00:24,770 Have accumulated in better care and with more. With that comes increased complexity and more risk of of things going wrong. 3 00:00:24,770 --> 00:00:38,930 Uh, I think that's. The psychological pressures and everything else is in great danger of producing a risk averse behaviour, 4 00:00:38,930 --> 00:00:44,100 which in the end I think may not be that good for everybody. 5 00:00:44,100 --> 00:00:53,780 Oh, yeah. I think that the trouble is you're never criticised for doing things that potentially are more harmful. 6 00:00:53,780 --> 00:00:57,680 And they said you will never be criticised for admitting a patient to hospital. 7 00:00:57,680 --> 00:01:01,340 You'll never be criticised for keeping them in an extra couple of days. 8 00:01:01,340 --> 00:01:08,890 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. 9 00:01:08,890 --> 00:01:16,820 So I think that that a lot of this litigiousness, immigration, aggressive behaviour we've got, 10 00:01:16,820 --> 00:01:27,050 um, may result in more risk averse behaviour, which may have indirect bad effects. 11 00:01:27,050 --> 00:01:33,330 I think doctors are paid to make those clinical judgements and clinical judgements and an assessment of risk. 12 00:01:33,330 --> 00:01:40,310 Yeah, and I know neither decision is ever a risk free, but if you try and make the one that's always risk free, 13 00:01:40,310 --> 00:01:45,090 that's often to do the wrong thing and treatment plans are there or not. 14 00:01:45,090 --> 00:01:50,060 Yeah. And what happens if you don't fill? Well, that's where they were. 15 00:01:50,060 --> 00:01:58,600 I mean, I said, well, I think that's very interesting because. 16 00:01:58,600 --> 00:02:04,630 We talk on the one hand about individualised treatment plans for individual people and personalised medicine, 17 00:02:04,630 --> 00:02:14,140 and on the other hand, we have just a tsunami of guidelines that whether the guidelines are, 18 00:02:14,140 --> 00:02:16,240 you know, their only guidelines well, 19 00:02:16,240 --> 00:02:21,650 they're only guidelines until you don't follow them and he goes wrong and then you find out something quite different. 20 00:02:21,650 --> 00:02:26,320 Uh, guidelines, if you don't follow them, it all goes well. And every worries about that. 21 00:02:26,320 --> 00:02:29,590 And I think the, um. But that's fine. 22 00:02:29,590 --> 00:02:32,890 That's not the kind of the general medical sphere where things are clear. 23 00:02:32,890 --> 00:02:43,390 But when you look at things like cancer, chemotherapy and radiotherapy, you've got treatments that are effective. 24 00:02:43,390 --> 00:02:50,950 But at the moment you end up with very toxic treatments and then guidelines. 25 00:02:50,950 --> 00:02:54,580 If you if you don't follow the guidelines in those spheres, 26 00:02:54,580 --> 00:03:00,430 I think life can be very difficult because things can go wrong because the drugs are pretty toxic. 27 00:03:00,430 --> 00:03:05,380 And the guideline is that you're not getting a lot of benefit. 28 00:03:05,380 --> 00:03:12,500 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. 29 00:03:12,500 --> 00:03:24,400 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. 30 00:03:24,400 --> 00:03:40,200 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, 31 00:03:40,200 --> 00:03:46,170 much easier to pull a guideline off the shelf than to think through the problem. 32 00:03:46,170 --> 00:03:54,090 And I think that's perhaps the biggest change is that, yeah, I think we all, before this became the norm, 33 00:03:54,090 --> 00:04:02,700 had our own guidelines that we developed and thought through either from experience, colleagues, original reading. 34 00:04:02,700 --> 00:04:10,380 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. 35 00:04:10,380 --> 00:04:15,000 But I think losing the skill to work out how you do it is perhaps not a good thing. 36 00:04:15,000 --> 00:04:26,310 And I think that is anxiety provoking. And I just wonder whether dogs will be able to balance in my field. 37 00:04:26,310 --> 00:04:31,530 You may have three guidelines, conflicting. 38 00:04:31,530 --> 00:04:39,150 How do you work and what's the right thing for the patient? I think the skill to do that requires. 39 00:04:39,150 --> 00:04:44,400 Time, experience, but a willingness to take on the challenge. 40 00:04:44,400 --> 00:04:50,850 How have you written much books, papers now that I to after people? 41 00:04:50,850 --> 00:04:59,240 Very good. Where do you think nowadays you start more new treatments or stuff for patients? 42 00:04:59,240 --> 00:05:04,590 Yeah. Oh, I made a career out of stopping at the stop and treatments that my colleagues started. 43 00:05:04,590 --> 00:05:06,090 Yeah, yeah. 44 00:05:06,090 --> 00:05:17,460 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. 45 00:05:17,460 --> 00:05:23,880 And when I first hear the idea of polypharmacy, we all understand that's a problem. 46 00:05:23,880 --> 00:05:28,110 But when you look at things in terms the variety of drugs, 47 00:05:28,110 --> 00:05:32,850 they're not because you've got vascular disease, you know, not because you've got respiratory disease. 48 00:05:32,850 --> 00:05:38,380 And there's no obvious place to kind of say, well, you don't need that. 49 00:05:38,380 --> 00:05:47,640 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. 50 00:05:47,640 --> 00:05:50,400 So it is it's become increasingly difficult now. 51 00:05:50,400 --> 00:06:00,780 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. 52 00:06:00,780 --> 00:06:14,190 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. 53 00:06:14,190 --> 00:06:19,850 So I've got my name on quite a large number of posters which have supported junior doctors, 54 00:06:19,850 --> 00:06:30,030 because one of my big bugbears is that the average new I think one of the other big problems to the 55 00:06:30,030 --> 00:06:40,750 profession lies around the lack of statistical and numerical skills in the medical profession. 56 00:06:40,750 --> 00:06:52,590 Mm hmm. Um, which for a profession that is largely built on a probability of disease, X or Y, 57 00:06:52,590 --> 00:07:03,060 and whose treatments rely heavily on the results of statistical analysis of trials, the lack of numerical skill in the profession is one thing. 58 00:07:03,060 --> 00:07:12,360 And I actually kind of get quite interested in maths and statistics and spend time with the trainee. 59 00:07:12,360 --> 00:07:19,260 Just pointing out that if you need to think about the analysis before you collect the data and just simple steps, I mean, um. 60 00:07:19,260 --> 00:07:24,020 And so I've got I've got a background in statistics, so. 61 00:07:24,020 --> 00:07:36,110 And doing that is quite helpful, but I am disappointed in me, the lack of appreciation of that being newly qualified doctors go. 62 00:07:36,110 --> 00:07:41,900 What was your thesis on race between, you know, my my um, 63 00:07:41,900 --> 00:07:51,040 my Ph.D. thesis in London was on autoimmunity and the homo right with Bloom is deeply part of it. 64 00:07:51,040 --> 00:07:59,340 Yes. And, um, and Deborah Doleac I so it's a kind of an interesting, interesting mixed area. 65 00:07:59,340 --> 00:08:08,940 Nobody could work out whether it was the chronology, gastroenterology or what, but that was where I did my original empty. 66 00:08:08,940 --> 00:08:13,730 Well that's a lovely and really thank you very much indeed. I think we ought to stop that right now. 67 00:08:13,730 --> 00:08:16,911 And many, many things that I've got is.