2024: A year to reinterpret medicine’s maladies

In Jumpha Lahiri’s Pulitzer prize winning book The Interpreter of Maladies Mr Kapasi is a driver and tour guide who also works as a medical translator. Kapasi’s duty in the doctor’s clinic is to translate without passing judgment. His passenger describes Kapasi’s translation job as “romantic,” something that surprises him and would equally surprise most people working in today’s healthcare environment of systemwide maladies.

Taking a less romantic slant, Helen Salisbury says that “others in the consulting room” bring their own benefits and challenges (doi:10.1136/bmj.q35).1 “Interpreters of maladies” are part of the medical team—and the nature of that medical team is being redefined. Rammya Mathew describes how rising demand in primary care is increasingly met by clinical support staff, meaning that practices need fewer locum doctors (doi:10.1136/bmj.q15).2 Mathew’s concern is that these new support roles will result in a “lost tribe” of doctors, who were attracted to—and relied on—locum work, leaving general practice.

Scarlett McNally’s hospital trust has won awards for introducing doctors’ “assistants,” who provide “admin, basic clinical skills, and communication with patients and across teams” (doi:10.1136/bmj.q19).3 The idea is that doctors stop spending time on activities that don’t require a medical degree. McNally is committed to increasing her productivity “by 30% with administrative support” and believes that the scheme is worthy of a national rollout.

Another potential solution to the workforce crisis in health and care is to redefine medical training and widen access to a medical career, encouraging people to train and work locally. Medical apprenticeships are one such proposal in the underwhelming workforce plan published by NHS England last year. Éabha Lynn tries to compile what we know so far from planned pilots, but the lack of detail about these roles has fuelled speculation and misinformation (doi:10.1136/bmj.p2939).4

Unlike medical students, apprentices will be paid, although the level of those payments is unlikely to be enough to properly widen access and may even breed resentment in others who are accumulating £100 000 of debt to end up with the same qualification. Training opportunities, already insufficient, will come under further pressure. The commitment to work locally after qualification also seems highly complex to enforce. If the result is a two tier system, two tribes going to war over income, training, and career progression, then the initiative will have failed.

One issue at the heart of these matters—and the workforce crisis is a global one (doi:10.1136/bmj.q7)—is better job satisfaction.5 Newly qualified doctors in the UK begin their careers with huge debt, insufficient training opportunities, and no sense of belonging since the demise of the hospital “firm.” By the time they have completed their postgraduate qualifications doctors are likely to remain mired in debt, starved of training and team spirit, and belittled by still being called “junior.”

All this plays out against the backdrop of ongoing industrial action (doi:10.1136/bmj.q46), a health service that will take a decade to recover from the shock of covid and post-covid—“a continuum of perfect storms” (doi:10.1136/bmj.q11)—political decisions that have made the UK a country that is “poor and unhealthy, where a few rich, healthy people live” (doi:10.1136/bmj.q41), and an immigration policy that will worsen staff shortages with its hostility to migrant health workers (doi:10.1136/bmj.p2915).6789 The maladies, therefore, run from individual level to system level.

The BMJ’s values are to be evidence based (doi:10.1136/bmj-2023-075462 doi:10.1136/bmj-2023-076226 doi:10.1136/bmj-2023-076227), patient centred (doi:10.1136/bmj.p2777), open and transparent (doi:10.1136/bmj-2023-076902), courageous (doi:10.1136/bmj.o838), and proud of our people (doi:10.1136/bmj.p2755).10111213141516 Our purpose is to prioritise outcomes related to health and wellbeing, for people and the planet. In a year in which medical roles, medical teams, and the delivery of medical services—damaged by the maladies that run through them—must be re-examined and redefined, The BMJ’s values and purpose would be a good starting point.

Welcome to 2024, the year of reinterpretation of maladies.