David Healy: The Shipwreck of the Singular
Hector Warnes’ comment on Samuel Gershon’s comment

                I congratulate Professor Gershon's response to Healy's profound analysis of a seemingly ongoing crisis in medical care.

In spite of great technological and therapeutic advances (which in general have increased our life-span) there are areas of concern on which we all would agree, namely the increased dehumanization, bureaucratization, utilitarianism andchange of communication (digitality).  Various set-backs are underlined by Professor Gershon, such as the doctor-patient as well as the doctor-doctor relationship, the excessive reliance on saving time and the inordinate importance given to the latest technological advances of medical praxis. 

This practice is called defensive medicine because of the doctor's fear of being sued or doubting his clinical skills or perhaps for fear of making a mistake.  The excessive reliance on technological medicine greatly increases the cost of medical practice.  Long ago (it was mentioned by Professor Gershon) a careful semiological or clinical examination, along with an approach that included the family of the patient without regard for the time it took, would have been sufficient in order to reach an accurate diagnoses and adequate treatment. 

There is no doubt that for   more than50years great social and family changes have affected the nature and values of our professional, social and family life.  The density of the sick population in hospitals hasgreatly increased which, in turn, has also affected the quality of care and staff-patient relationship. 

Few of us have time to listen attentively or to devote more than the minimal time affordable for a given task particularly because of the oftenstressful setting or the massive pressure to see every patient waiting for us.

A nurse-practitioner would be a bridge to help us in the initial evaluation and be able to sooth or assuage the patient's anxieties about his or her symptoms besides having a caring person listening to his complaint.

I shall quote Professor Gershon's cogent statements:

"I wish to add (to Prof. Healy) my pent-up unhappiness to some of the issues raised by my colleagues..." Healy's essay has given us "their unique contributions to these mountain cracks and fissures in our medical edifice..."Further, he emphasized that "current corporate models of medical practice have essentially outlawed this form of medical care " (referring to the meticulous clinical examination and the value placed in the doctor-patient relationship and optimal socio-medical setting).

Finally, Professor Gershon rightly noted that "we have played a major role as enablers in this outcome" (referring to the Big “bad”Pharma and the Medical Industrial Complex).

Apart from the few remarks I inserted at the beginning of my comments I am in total agreement with Professor Gershon.

September 20, 2018