Each year the Reith Lectures come round as Radio 4’s annual assertion of intellectual authority, fulfilling the BBC’s original aspiration to inform and educate (although not always to also entertain). Each year, though, it’s hard not to feel a certain resistance to Lord Reith’s lofty legacy. Radio might be the perfect format for delivering a talk. Perfect for the lecturer because there is just an audience of one to focus on. Perfect for the listener because there’s nothing else to distract you. No intrusive soundscape. No other voices to confuse. But not all intellectual giants have the ability to communicate, nor an understanding of radio’s particular qualities. Sometimes the lectures sound as if they’re going to be jolly hard work, requiring the time (and energy) to listen, really listen to what’s being said about a subject that you know you should know more about but feel a bit daunted by.
This year, though, we’re being given a cracking series (produced by Jim Frank) by the American surgeon and writer Dr Atul Gawande. It’s not just that his chosen subject, The Future of Medicine, is of direct, not to say intimate, interest to everyone listening. How will we be cared for in later life by an NHS that’s already in crisis? Gawande is also a brilliant communicator. Listening to the second lecture, when he told the story of the three-year-old Austrian girl who was brought back to life after being underwater in an ice-cold pond for half an hour, you could hear the silence in the room, not a rustle of paper or a single coughing fit.
Gawande, who has written a book called The Checklist Manifesto, argues that what we face now in our health systems around the world is not a cashflow crisis, or a lack of knowledge, but a crisis of complexity. We have too much knowledge, and not enough intellectual capability to process it effectively. His solutions sound so easy; not to say too easy — except that he also gave us vivid stories to show just how effective such solutions can be. In the case of the Austrian girl, she was cared for in a small community hospital, not a state-of-the-art specialist facility. What gave her life was the simple fact that not a single person among the hundreds who cared for her made a mistake. Everybody had to do everything right. Any small mistake could have been fatal. A nurse who forgot to wash her hands just the once could have brought bacteria into the child’s open chest wound. ‘Game over,’ said Gawande, not wasting a word.
‘We have been fooled by penicillin,’ he suggested. Six million people across America and Europe pick up an infection while in hospital because someone has failed to follow basic infection-control procedures that have been known for decades. His solution is to set up simple but detailed checklists. A solution that, he says, 20 per cent of surgeons really resent having to use — but 94 per cent admit they would want the team treating them to use if they ever found themselves under the knife.
Trauma Medicine, also on Radio 4 (produced by Rami Tzabar) in another subtly designed example of synchronised scheduling by the controller, echoed Gawande’s thoughts. Dr Kevin Fong works for the air ambulance service and he, too, through experience has learnt that what often saves people are the systems rather than the medicine. In the first stages of an emergency, those first moments after the shock, the trauma, what counts is the speed with which some degree of order is introduced. Fong, too, gave us a vivid example, which like Gawande he told with the skill of a true storyteller.
In February 1976 an American surgeon, Dr Jim Styner, crash-landed a plane containing his entire family in rural Nebraska. His wife was blown out of the aircraft and killed and his four children were critically injured. He himself suffered broken ribs and a fractured spleen but he knew he had to get his children out and drag them to safety, fearing that the plane would catch fire. He then had to drag them back into the plane once he realised no help was on its way, and the only shelter from the bitter cold was inside the damaged aircraft. Next he had to crawl through the woods to the nearest road and flag down a passing car for help. But once in the hospital he was horrified to discover that the doctors and nurses were not able to provide the right care. They had no experience of dealing with multiple and critical injuries.
He initiated Advanced Trauma Life Support, a system of protocols designed to manage an emergency in those crucial first minutes. Fong himself first saw ATLS in action after the nail-bomb explosion in Soho in 1999 where in an instant almost 80 people were injured (and three were killed). He came up with the surprising (to me) assertion that trauma is not a collection of injuries produced in a moment: ‘It’s a disease.’