Putting A Man On The Moon

When some VIPs were being shown round the NASA launch site for the Apollo mission, they came across a man sweeping the floor. When they asked him what he was doing he replied “I’m helping to put a man on the moon”.

I came across this possibly apocryphal anecdote when I was clearing out my desk. It had been used by a NHS leadership fellow, who I was mentoring, to argue that the core of leadership was being able to have a vision and inspire people to share it.

In the same purge I found a copy of the Primary Care Society for Gastroenterology journal from March 1989. In it I had written a piece on the value of making a positive diagnosis in Irritable Bowel Syndrome (IBS):

‘By making a positive diagnosis, patients would be spared unnecessary investigations, reassurance could be given early and fears of serious organic disease dispelled. This would not only save patients unnecessary discomfort but would also save as great deal of money’.

This could equally well have been taken out of a recent copy of the Digest. Pre-dating the NICE guidelines by nearly 20 years it remains as true today as it did then.

Worryingly this serves to demonstrate how little we have managed to share this vision and inspire others to act on it.

One definition of hell is doing the same thing over and over and expecting a different result. It feels that we have been doing that in this case. Maybe we should have a radical re-think of how to treat IBS? Our GP colleagues are not comfortable making a clinical diagnosis it seems. It is hard to escape gastroenterology outpatients without an endoscopy whatever you are referred for and IBS is still often taught as being a ‘diagnosis of exclusion’.

Perhaps we should accept the reality of the situation though it feels defeatist and negative.

Alternatively we need to keep the message but change the way we are giving it. If ever there was a case for those ‘leadership’ skills in having and sharing a vision this is it. Firstly with the way we are educating doctors and then teaching the same skills so that the GP, confident and secure in the diagnosis, can share their vision of the best management of the condition and inspire concordance and understanding in the patient.

Let’s try that and appreciate that medicine is not just about science: more about the application of that science.