So, what is Rethinking Medicine and exactly what needs to be re-thought? Medicine is constantly changing – so, what has happened that requires us to rethink the process and perhaps bring it back into line?
 
Medical training and care provision have developed throughout the centuries to recognise the current knowledge as well as reflecting disease profiles and social mores. It is imperative that medical training and on-going professional development are based on the needs of individual patients and the population who will benefit from the resultant knowledge and skills. 

Rethinking - interesting choice of word. Not review or assessment - more radical. Rethinking is a form of investigation not bound by the past, nor by a process and not constrained by the ecology of the future. Unlike the other option, a review, it is born of inquisitiveness, nourished by anarchy and unpredictable in its outcomes.

I cannot help but think that the group has given itself the harder of the two options. ​ 

Change takes time. We need to prepare for the future not just firefight the present. It's a popular time to wheel out some of health policy's favourite clichés. But how do you define long term? And how does knowing a realistic end point affect what you do now?
 
Let's start with what you're trying to achieve. You need to consider the scale of change needed, but also quite how embedded the status quo is. Trying to reverse decades of hospital dominance sounds like a task for at least a decade. Balancing the attention given to physical and mental health is likely to be even longer.

The NHS Long Term Plan sets out a vision for the future of the NHS that begins to rebalance the way the NHS will care for the population for the next 10 years.

It focusses on care in the community, prevention, and addressing the biggest health challenges of our time. It is difficult, however, to change the culture of an organisation, but this is a good start. The difficulty will be in turning plans into reality. 

​It’s December 1995. A chubby four-year-old boy in a Thomas the Tank Engine woolly hat is crying.

He’s suffering from a very common ear infection that almost all children have experienced, ‘otitis media’. He’s crying because it’s painful.

Nearly 12 months down the line and I'm still calling Rethinking Medicine a 'thing' because I don't know what else to call it.
 
'Initiative' sounds dry, 'project' lacks ambition and 'programme' too managerial. The term 'movement' sounds grandiose and presumptuous but it comes closest to what we'd like to see. 

David Paynton

Ollie Hart

Doctors assume they know what needs to happen but find themselves frustrated that medicines are only half the answer.
 
We explore a shift in thinking as modern medicine rebalances itself to respond to the challenge of working with people rather than doing to patients.

Around the country clinicians especially general practitioners, are increasingly frustrated that despite ever increasing workload, efforts go unrewarded.
 
There is a feeling that although we face a faster treadmill of consultations, blood tests, referrals, QOF targets, contract indicators and regulatory requirements, the law of diminishing returns still applies.

David Griffiths

If we all agree that the medical model is outdated, why is it so resilient? This was one of the most insightful questions at the recent thought-provoking workshop for the Rethinking Medicine programme.

It was asked by Chris Van Tulleken, now a well-known media doctor, but back in the day a peer of mine at medical school. 
​
It prompted me to reflect more on the nature of the medical model, my own experience of it as a GP, and why it's so pervasive.

Ollie Hart

How often do we get a chance to think and reflect these days? We are pretty caught up in the doing, performing as the doctors and nurses we have been trained to be. But if you stop and have the luxury to think a bit, it does make you wonder if we are ploughing on with the right sort of 'doing'?
 
We tend to steer by the guiding lights of evidence-based medicine, well synthesized and simplified from the mountains of research that most of us are too busy, or ignorant, to contemplate. Mostly it comes from clever and ever more sophisticated biomedical insights.

Alf Collins

People come to see doctors with problems. They tell their story, the clinician examines them, clinches a diagnosis (perhaps after ordering a test or two) and then prescribes a fix. It's that simple. Occasionally. 

Much more often, people come to see doctors with complex stories of dis-ease, or with multiple conditions, many with their roots in the social determinants of poor health.