Letter: Realities of surgery

Sir: It is not often these days that one finds oneself in absolute agreement with a journalist writing about medical matters, but Jeremy Laurance's article "We're in danger of driving out our finest surgeons" (13 August) gave a clear, objective assessment of the situation regarding child heart surgery. I am disappointed that such balanced views are not expressed more in the media.

His last paragraph in particular summarises the problem, not just for cardiac surgery but also for many other aspects of child medicine, including my own area of paediatric oncology. Expectations have become too high, and it seems no one can die without it being automatically someone's fault.

As he points out, in the medical profession we must take some blame for raising expectations too high. Often because of the repeated distress when families are told of their child's life-threatening illness, doctors tend to soften the message, and offer greater optimism than perhaps is appropriate.

I have been privileged to work in an era over the last 30 years where expectation of survival from cancer and leukaemia has gone from nearly zero to a point where 70 per cent of patients live long-term, apparently cured of their disease.

In the early Seventies we offered little hope, and dealt with a lot of gloom, despair and catharsis, but also perhaps offered a more realistic approach to survival. Now we do indeed offer more hope than is appropriate: we must be better at facing the realities of risks and survival, even if that induces more family and patient distress than we would like to cope with.

O B EDEN

Professor of Paediatric Oncology

Manchester Children's Hospital

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