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Better value—the 21st century priority

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The following is an extract from Sir Muir Gray’s book Better value healthcare. Details about the book appear of the end of the extract.

THE MEANINGS OF VALUE

“Oh fuck!” said the surgeon, gazing at the liver newly exposed by his generous incision from the sternum to the umbilicus. Human liver looks like calves' liver or lamb’s liver—smooth, firm, shiny, and cerise. The human liver is a large organ. It lies just below the rib cage with a large lobe on the right side tapering to a left lobe which lies across the midline. The liver is a generous organ. It has more capacity than is needed and good health is possible even if half the liver is destroyed or removed. The liver is a bloody organ. The large amount of blood that flows through the liver means that cancer cells often lodge and grow in the liver to become metastases or secondaries, and these “liver secondaries” were regarded as a death sentence until advances in surgery and anaesthesia enabled surgical treatment, and perhaps cure, if the secondaries were situated in the left lobe of the liver which can be detached from the right, main lobe and removed.

Ten days before surgery, x-rays had found secondaries only in the left lobe of the liver, but when the liver lay exposed under the merciless theatre lights, little white specks covered the surface of the right lobe and the left lobe; surgical treatment would therefore be futile. “Oh, fuck!” said the surgeon and, after a pause, “Let’s go ahead anyway.”

THE TRAINEE'S PERSPECTIVE

That Catholics enjoyed themselves on Sundays was a cause of universal disapproval to Scottish Presbyterians in the 1970s, and a cause of envy to not a few. After Mass, Catholics could relax and enjoy themselves, although in a Scottish city in those days the opportunities …

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