Ann Y Coxon

Am I the only one still working ?

The problem with looking back is the perspective into a past that was so different, a present where you no longer fit in, and a future that is therefore unrecognisable.

I remember at Guy’s being taught compassionate, person centred, clinical medicine at a very high standard. Reflecting such borrowed feathers I was spontaneously offered teaching jobs at Johns Hopkins and Cleveland in the US so the brand was seen as valuable.

Today the explicit requirement of a Doctor is to be protocol driven, to work in teams that never see the same patient twice, and yet somehow adequately manage multisystem disease in the demented, language compromised frail humanity in front of you.

Patients love it that I can remember issues of drug allergy, previous investigations and minor illness they had forgotten because as a Guy’s graduate I was told the totality of a patients care is my responsibility.

Where I despair of patient care, I marvel at changing treatment options. A patient with TTR cardiac amyloid is back to playing golf on Vutrisiran, (cost £500,000 per annum, free on the HELIOS trial), hoping to be included in CRISPR trails where after one infusion with no side effects, he will have the same effect with no need for further treatment. Sickle cell anaemia, spinal muscular atrophy are no longer death sentences because of the same technology. But in  a world where starvation kills relentlessly, the cost of over £1 million for one life is questioned.

Because of cost, the rivalry of State v Private systems of care do not reveal that neither are adequate. Waiting lists in the State system have a mortality, and Insurance systems never seem to be able to pay for the treatment you need because of some small print, because they run on a profit motive.  There remains a serious problem in the delivery of care, which becomes a lottery.

It is sad to end a career of more than 60 years of active medical practice with recognition of an ideal not achieved, and a standard of careful practice learned from dedicated teachers that is now mocked by the NHS as a sign of arrogance. The banner has been passed to a new generation no longer interested in the values we thought important. But the intellectual momentum to discover the processes causing  illness reveals awesome progress inconceivable in the hallowed halls of Guy’s Hospital  1962.