Lovely sunny day, and in the afternoon I went and sat in a shady pub garden with a beer and a few cigarettes, and thought about the medical profession.
In the distant past, 50 or so years ago, the medical profession’s task – their calling – was that of curing the sick. If you got sick or injured, you’d go and see a doctor, and he’d examine you, and recommend a course of treatment (e.g. stay in bed for a week, and take a few aspirin every day). If this didn’t fix the problem, you’d go back again.
And doctors back then treated everyone alike. They didn’t mind if the patient was an enemy soldier or a serial killer. They were all treated equally.
Now, however, doctors seem to mostly practise preventative medicine. Instead of just taking people as they come, these new doctors try to prevent them from coming in the first place. The thinking has changed from “Here’s a sick man, so let’s try and set him right,” to “Here’s a sick man, so what did he do to get so sick in the first place?” It isn’t just bad luck for someone to get sick any more. It’s always their fault.
Got lung cancer? That’s because you smoke. Got liver failure? That’s because you drink. Morbidly obese? That’s because you eat too much. Got shot? That’s because you joined the army. Got the clap? That’s because you’ve been sleeping around. Got malaria? Shouldn’t have gone to West Africa. Got Zika? Shouldn’t have visited Brazil. Got Ebola? Shouldn’t have lived in Liberia. There’s always something someone could have done to prevent getting sick or injured.
The old doctors didn’t used to ask. They just saw someone who was sick or injured, and did their best to help them.
In many ways, preventative medicine isn’t anything new. Vaccination is a form of preventative medicine. So also are helmets for soldiers. And railings on staircases. But these kinds of preventative measures are non-intrusive: they don’t try to change the way people behave.
But the new doctors want to change the way people behave in ever more intrusive ways. People must stop smoking. And stop drinking. And cut their food intake. And get some exercise. And stay out of the sun.
The old doctors accepted people as they were, and did their best to help them. But the new doctors want to change the way people behave. They have become moral guardians of ‘healthy’ behaviour, replacing curates and vicars. They see it as their job to tell people how to live their lives.
Why has this happened? Why have these new busybody doctors multiplied, and the old non-judgemental doctors become more or less extinct?
One possible answer is that, if the medical profession is being snowed under by patients, they’re trying to reduce their workload by preventing many of them from getting sick in the first place. This is like army doctors appealing for a war to be stopped because too many soldiers are being killed and injured.
But another (almost opposite) answer is that, now that a great many transmissible diseases can be prevented (by vaccination) or treated (with drugs), most of the classical maladies have lost their danger – and the response of the medical profession has been to discover new diseases to justify the continued existence of their profession. In this respect the WHO’s claim that there is a “smoking epidemic” can only mean that smoking has itself become a disease, no different from cholera or rabies or typhus.
Or maybe it’s simply that the new doctors no longer do what the old doctors were able to do: suspend judgement on those in their care. The new doctors are as moralistic as anyone else, but instead of suppressing criticism, they are quick to voice it.
Or perhaps it’s that when medicine was nationalised (as it has been in the UK), the doctor-patient relationship changed. The patient ceased to be a paying customer, and so his opinion no longer mattered. Once the state started paying the doctor, the patient was still a customer, but he no longer paid (or withheld payment), and exercised no influence over the doctor.
The new doctors are different in other ways. With the old doctors, you told them when you got sick, and you also told them when you recovered. But the new doctors now tell you when you’re sick, and are indifferent to your own opinion how well you are. A couple of blood tests, and they announce that you’ve got cancer or Zika or Ebola.
I can’t say that I got to the bottom of it all this afternoon. But I at least raised a few questions. And proposed a few answers.