Without patients there is no healthcare system. We must act for their sake.

As a starter for 10, who said the following about a healthcare system?

“cause people often talk about being scared of change but for me I’m more afraid of things staying the same cause the game is never won by standing in any one place for too long”

Actually, I don’t think the writer was really talking about a healthcare system if I’m to be completely honest. I’m sure he’s a patient occasionally, though I doubt he spends countless hours staying up late, cup of tea in hand, leafing through BMJ and thinking about the machinations of health policy. Notwithstanding, I agree with him in all contexts, motion and momentum is critical to avoid stasis developing – it’s actually the secret sauce of good healthcare.

I’ve been travelling a bit of late, and, in doing so, I have had the opportunity to parachute into several different healthcare systems. Once the canopy settles and you’ve tidied your chute away it is only a matter of time before an objective view forms and a country’s approach begins to reveal itself. The health recipe has many similar ingredients: a mix of political, social, infrastructural, economic and technical tension with an underlying cohesiveness that always appears to be best played out by the patient.

That central tenet of the patient at the centre is extremely important. Let’s face it, if there were no patients, no one requiring medical attention, there would be no need for a healthcare system. In the absence of a utopia, it becomes very important for us to have a central understanding of the goal of our efforts. This is where the impressions of our patients’ pains, elations, depressions, indignities and triumphs, to name but a few, are vital to help us understand what to change, where to start and how to act. It is action that pushes us forward.

I have noticed in the developed West, we sometimes make acting difficult for ourselves. Tied down by political stasis, underfunding, extreme risk aversion, unwieldly procurement practices and sometimes, a touch of fatalism, there seems a frequent and pervading sense of “this is our lot, this is what we’ve got.” At these times, there’s often an overwhelming feeling that a lot of what is done is quite bloated and removed from the central aim of caring for the patients themselves. A great way to get back to the centre is to stop. Listen to the opinions in all shapes and sizes, from different intellects, social positions and economic constraints. When these diverse ‘voices’ start to tell you the same thing, it’s a great time to be listening to your patients’ journeys.

Change is good when it makes things better.

So, was it Atul Gawande? Was it Paul Kalinithi? Was it Tedros Adhanom? Or had I just been on a plane for quite some time, headphones in, listening to Nick Cave? Often the gems come from the places you’d least expect.