IML: How has the pandemic changed the experience of medicine, from the perspective of patients and providers?
Hendry: Clearly, technology has taken us to a place that, pre-COVID, we wouldn’t have dreamed of going. We don’t think twice anymore of having a video call or a video appointment. Lots of consultations can take place remotely. For child and adolescent psychiatrists, for example, this change has been very positive because young children and teenagers hate going in to wait in a grubby waiting room. It’s much easier for them to do it from home and not have to take time out of school.
From the British point of view, the National Health Service (NHS) grew out of the collective trauma of World War II. While it’s difficult to criticize the NHS, it is challenging to get it to adapt and modernize to changing conditions. The costs are going up and the dissatisfaction is rising and we’re not creating a healthy society.
IML: How might that mindset change?
Hendry: It’s already changing. I wonder why we’ve made it so difficult for patients to get
care. The reason for that, I think, is that particularly in America and the U.K., we designed
the system for the convenience of staff, not the patients. The days before technology, if I was a
specialist and wanted to see patents, it was easier for me to schedule a clinic at one time, get
all the patients to come in, get their labs, and wait until I was ready to see them.
With technology, you can get care for so many things remotely. In the old days, I could only offer you medical care within a certain locale. Today, I could potentially do it from anywhere in the world. If I’m living in a lower cost economy, I could potentially undercut local providers. This creates the potential for medicine to evolve into more of a transactional model. When the care is being delivered to patients in another territory, health professionals also need to assure
themselves that they are adequately protected.
IML: What are the implications of that model?
Hendry: Take CT and MRI machines. In the past, only the largest, most sophisticated hospitals
had these machines. Today, many doctor’s offices have them. So maybe if you have a headache, you can get a CT scan to reassure you that you don’t have a brain tumor.
IML: How does this approach impact the role of medicine in our society?
Hendry: It may be that medicine should only be intervening if there is a “mechanical” issue
like a tumor or a vascular problem. We need to think about how we’ve been medicalizing the
human condition. If your headache results from the fact that you are in an unhealthy personal
relationship or horrible job, is that a medical problem? Should you see a doctor, or talk to a friend or see a therapist instead?
We have to think more about where medicine can add value and what we can do to make medicine more available and affordable. That means directing resources to where you can make the most impact, rather than providing consultations and tests to the most affluent sections of society.
IML: How does this apply to medical professional liability?
Hendry: The challenges for liability insurers are numerous. First of all, the courts and the law have a very traditional view of medicine. They always used to say that the courts are about 20 years behind, but with COVID that might now be 50 years.
How does the average judge or jury even understand how medicine is changing? It’s a huge challenge for the legal and judicial system to even grasp the intricacies of professional responsibility, liability, and the various
tests for negligence.
IML: What other issues are involved in this dynamic?
Hendry: The system we have right now focuses on individual liability and blame. But if we move to more of a public health model—which seems logical in the midst of a public health crisis—then medicine and healthcare aren’t just an individual concern, they are societal concerns. How, then, do you allocate resources? And how do you compensate when things go wrong?
IML: What are the downsides of the current focus on individual liability and blame?
Hendry: It’s a very individualistic, very old fashioned and, frankly, a very medieval constraint, really. It’s no secret that the current system is becoming unaffordable and, to a great extent, unjust. In the U.K., a significant percentage of medical professional liability claims come from maternity claims. If you can prove negligence on the part of a healthcare worker, you might recover multi-millions to look after your child with cerebral palsy with a hydro-therapy pool and a specially adapted car. But if you fail to get over that hurdle, you get nothing. How is that socially equitable? It’s bad for society and it’s unsustainable.
Ultimately, this begs the question of what we want from our healthcare system and from our doctors. Coming from the insurance side, how do we compensate people who suffer avoidable harm as a result of that healthcare? What do we do for families with children with special needs? At the moment it suits politicians to leave these questions in the space of medical professional liability and let the doctors, judges, juries, and courts squabble about that. I think the medical profession and the medical liability insurers should be telling the politicians that this is not an appropriate way to handle these situations.