I wanna make a difference

Has he made a difference?

What difference do doctors really make? There is a school of thought that if we take the last 100 years and balance out the iatrogenic harm and the benefit, it comes out at neutral. Most benefits to health have come through public health measures, like better sanitation and diet. If we took the Quality and Outcomes Framework to Africa, it would make scant difference to their health. They need food and water. As a colleague wrly pointed out recently, "you can't get IBS if you don't have three square meals a day".

My last patient was a lovely old lady with a sore shoulder. Examining her, I found only tight muscles and I smoothed out the knots in her trapezius with some gentle movements. "Don't worry...it's nothing serious. You've just pulled some muscles". Her relief was obvious. If I were 90 and had a persistently sore shoulder, I would think I had shoulder cancer...with brain mets.

I helped her put her cardigan on before she left. Was that the most helpful thing I would do today?