Friends in Low Places by James Willis

Friends in Low Places Reviews

• 
  Sally

  I picked this up on a shelf in the staff room at a surgery I visit. The title intrigued me.
  
  It was published in 2001 but aside from a few out of date references about CD-ROMs and mobile phones, it could have been published today!
  
  In short, it is written by a GP, coming towards the end of his career as the changes were starting to come thick and fast in the NHS about evidence based medicine and improving standards.
  
  I sympathise with those generation of clinicians, who will have been straddled between 'gung-ho' approaches of 'trust me, I'm a doctor' and trained in the 1960s \ 70s (by people who were conceivably entering the profession themselves in the inter war years but most certainly prior to the introduction of the National Health Service) and the post Thatcher years where the road to privateisation was gaining momentum.
  
  SO many times I exclaimed out loud 'yes!' to his views and perspectives, seeing now, with the benefit of hindsight, how the strategies, approaches, new legislation and government departments (which have come and gone several times over since the books publication) have eroded a professionals autonomy and respect for their judgment over performance indicators and evidence.
  
  He speaks with passion about how he can see it happening around him and he and his colleagues are seen as dinosaurs, thwarting progress (which in some cases was going full circle back to previous practices) which will be for the benefit of the patient.
  
  I am slowly being more curious than critical of this generation, trying to understand why they 'laid down' and took what was coming rather than fighting back. Responding with 'roll on retirement' or stepping aside from their work early because of technological advances they felt ill equipped to embrace.
  
  As a clinical practitioner myself, I find it great earning to read the words off sometime who practices in the same was as I try to, with compassion and common sense, maintaining a sense of what performance indicators REALLY are - being there in someone's time of need and helping them make the system work in their favour.
  
  He articulates so precisely how I feel, that the meaning of policies have gone from supportive and advisory to rules and instructions, removing the spacer for flair and experience to prevail. He shines a light on the part the media has played in this shift, sensationalising one of errors, misjudgements, a perfect storm bringing about a sad situation but normalises it by saying how perfection is unattainable.
  
  Everyone makes mistakes, has a bad day, misjudges something, takes too long to respond but when it could result in loss of life or needless pain, it must be viewed in a differently light but nontheless, doctors are not infallible and mistakes with undoubtedly happen. Things have now become focused on rare and extreme cases and increased the levels of justification and governance that it has put clinicians in a position of fear and over prescribing 'just in case' to 'cover themselves'. This defensive documentation practice is taking time away from the people who need it most and it could be argued that being told what to do by instruction, takes away the opportunity to learn or think outside the box in complex cases.
  
  A snap shot of time in the delivery of our nations health from the front line, a great book to prompt discussion and a focus to affirm your practice