A very interesting article, although I can't help but feel that it tars doctors with slightly too broad a brush.

For the sake of context, I'm in the UK (so med school is a 5 or 6 year degree, not an undergrad and postgrad like the US), my fiancee is an Obstectric Surgeon (aka an Ob/Gyn) who's half way through specialist training (six years out of med school, three years training in her specialty), my father is an Oncologist (clinical, not surgical, though a lot of interaction with surgeons as would be expected) in his mid-sixties (so med school was forty odd years ago, consultant for over thirty years) - he is, however, both research focused and head of his department so is far more aware of current trends in the NHS than someone who's purely a clinician who wouldn't have much reason to keep up to date with the current literature or thinking in the NHS.

It's interesting to compare and contrast the mindsets and training they both have. A large number of the points raised in the article have been, from what I can tell, incorporated in the training that doctors receive these days - there have been changes to how surgical teams work to help break down barriers between the surgeon(s) and everyone else in the room. In the current NHS thinking the idea of surgeon-as-god is long gone, and even little measures like everyone in the operating theatre introducing themselves before the operation starts go along way to breaking down the formal barriers between the staff.

However, medicine is a very traditional discipline and it can be hard change the way people practice when you're trying to fundamentally change something they've been doing for the last twenty years. From the stories I hear from my father, there are more than a few surgeons of his era who do take the view that they can do no wrong and errors happen as a result. Thankfully, people of that mindset are mostly approaching retirement age and the generation of doctors below them seem to be more open to new ideas - something I suspect is an artefact of being trained during the eighties onwards when lots of fields of medicine became a lot more research focused and less interested in doing things because "that's how it's always been done". Quite likely also due to increased collaboration with colleagues around the globe suddenly being possible so new ideas spread faster.

It's also difficult to talk about the NHS as a whole. Every NHS trust (every geographical area in the UK falls under a particular trust that encompasses one or more hospitals) is slightly different, as there's a degree of autonomy within each trusts. Each deanery (the group of hospitals that a doctor does their specialist training in) is different - the quality of training you'd get in a deanery which is recognised as delivering world class training in your specialty is going to be entirely different than if you end up at a random deanery that has little connection to your specialty. Like any other area of academia, the best people tend to clump in certain places.

This means that, to the detriment of the NHS as a whole, just because some hospitals and trusts change the status quo and improve matters, it doesn't mean that it will spread immediately to everywhere else. It's sad, but perhaps not too surprising when you consider the size of an organisation like the NHS - were you to add them all together, it's an organisation with something in the order of 1.4 million employees, so it perhaps should be a surprise that chance is often slow. Doubly so when you consider that it's a profession that likes to see an idea proved before it's implemented.

On the upside, my fiancee will be spending the next year (from Sept) as an education and simulation fellow where she'll be designing and running simulations for junior doctors. Making sure that they can recognise when the blinders start to slip on and empowering them to speak up when they think that something is going wrong, even if it means telling someone several decades their senior to stop what they're doing, is surely one of the most useful things we can do to ensure that problems like the one in the article are kept to a minimum.