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Book review: The State of Medicine by Dr Margaret McCartney

Dr Nishma Manek reviews

the state of medicine jacket

'The NHS is the closest thing the UK has to a national religion…But it is also under pressure, underfunded and unravelling at the seams.'

These words on the back of Dr Margaret McCartney’s latest book, ‘The State of Medicine’, caught my eye. Once I opened the first page, it was harder to put down than I had imagined.

Following on from her two previous books, ‘The Patient Paradox’ and ‘Living with Dying’, Dr McCartney’s latest work seeks to dispel the myths surrounding healthcare. This time, her carefully reasoned iconoclasm has been scaled up to settle on the NHS as a whole, written with her customary fluidity and panache.

Dr McCartney argues that political short termism, repeated disorganisation, and non-evidence based policy making have caused lasting damage to our healthcare system. It’s a case well made, with a blend of rigorous analysis and illuminating personal anecdotes from the frontline.

With her usual fluency and powerful prose, Dr McCartney takes the reader on a fascinating journey of the non-evidence based policies littered throughout the history of the NHS. Far from being an opinionated rant however, she uses a weight of evidence and a healthy dose of insufficiently uttered common sense to lead us to the final chapter, where she puts forward nine proposals for making health policy.

The most compelling of these for me was the last: the need to put values first- before evidence, before policy, before politics. As she eloquently purports:

‘The joy in medicine is still there to be had. It rests on relationships. When we make the systems we work in better, we can make ourselves work better. There is no better work… the NHS is the best practical demonstration of human values that exists’

Intelligible, quick reads are hard to come by in this space. For anyone working in or with the NHS, I would certainly recommend you give this timely, persuasive book a try.


The State of Medicine by Margaret McCartney is published by Pinter & Martin £11.99.

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Readers' comments (2)

  • "Dr McCartney argues that political short termism, repeated disorganisation, and non-evidence based policy"
    Looking forward to reading this one;one of the better though by no means only author repeatedly making these points
    Sadly I anticipate an absence of analysis,as one might see in a text by Max Hastings,Anthony Beevor etc
    1 Why does it keep happening
    2 Why are GP's repeatedly hoodwinked
    3 Could it possibly be a direct function of the institution itself

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  • answer to all of the above is NHS workers are institutionalised and treat the NHS as a religion rather than a job as healthcare staff elsewhere would so they do silly things politicians ask and don't argue for fair pay or work life balance.

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