Jeremy Laurance: Proof that high standards are the best treatment

Medical Life

One picture can define a premiership. There is that famous shot of Margaret Thatcher, wiping away a tear as she departed No 10 for the last time – betraying an emotion she never showed while in office.

The final moments of Gordon Brown's tenure were captured in an extraordinary image, as he posed for the camera with his family inside No 10, an arm round three-year-old Fraser perched on a desk, moments before stepping out into the street to announce his resignation.

The picture has been much commented on. But one poignant aspect has been missed. Mr Brown described his role as prime minister as "the second most important job I will ever have", after that of husband and father. What is the greatest fear of a father (or mother)? That their children will die before them.

Mr Brown, at 57, is no longer young. Even so, it will be touch and go whether he outlives Fraser, who has cystic fibrosis, the commonest inherited condition in the West. The gene defect that causes the condition thickens secretions throughout the body, making them dry and gluey, and has a lethal effect on the lungs, whose airways fill with sticky mucus.

There is no sign of this in the boisterous child in the photograph. But the future Fraser can look forward to will depend to a critical extent on a neglected but crucial aspect of medical care: expectation.

In the 1950s, a child born with cystic fibrosis lived on average until the age of three. Today, thanks to improvements in care, that has extended to the mid-30s. Most patients are now cared for in specialist centres that have built up years of experience in managing the condition.

Yet there remain, as US surgeon and writer Atul Gawande noted in his 2007 book Better, shocking gaps in performance. The best centre in the US, Fairview Children's Hospital in Minneapolis, had a life expectancy 50 per cent better than the average. It's oldest patient was 67.

What accounts for the difference? The best centres were not using different drugs or treatments – they were just applying them better. Successful treatment of cystic fibrosis requires extraordinary commitment, attention to detail and a refusal to accept second best in order to maintain peak lung function. While the average centre might accept lung function at 75 per cent of normal, at Fairview they were not content with less than 100 per cent. They questioned everything when standards slipped, rather than accepting it as an inevitably by-product of the illness. Expectation was the key.

The treatment Fraser and his fellow patients receives will provide a touchstone for the performance of the NHS. Instead of searching for the easy fix, the miracle cure that will solve a problem, it needs to focus – in these straitened times – on diligence: doing what it has always done but doing it better. As Gawande said, the reality is that most clinics and most doctors will be average. That we must accept. What is troubling is not just being average, but settling for it.

PROMOTED VIDEO
Life and Style
ebookNow available in paperback
ebooks
ebookPart of The Independent’s new eBook series The Great Composers
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Recruitment Genius: Account Manager

    £20000 - £35000 per annum: Recruitment Genius: This full service social media ...

    Recruitment Genius: Data Analyst - Online Marketing

    £24000 - £35000 per annum: Recruitment Genius: We are 'Changemakers in retail'...

    Austen Lloyd: Senior Residential Conveyancer

    Very Competitive: Austen Lloyd: Senior Conveyancer - South West We are see...

    Austen Lloyd: Residential / Commercial Property Solicitor

    Excellent Salary: Austen Lloyd: DORSET MARKET TOWN - SENIOR PROPERTY SOLICITOR...

    Day In a Page

    Isis in Iraq: Yazidi girls killing themselves to escape rape and imprisonment by militants

    'Jilan killed herself in the bathroom. She cut her wrists and hanged herself'

    Yazidi girls killing themselves to escape rape and imprisonment
    Ed Balls interview: 'If I think about the deficit when I'm playing the piano, it all goes wrong'

    Ed Balls interview

    'If I think about the deficit when I'm playing the piano, it all goes wrong'
    He's behind you, dude!

    US stars in UK panto

    From David Hasselhoff to Jerry Hall
    Grace Dent's Christmas Quiz: What are you – a festive curmudgeon or top of the tree?

    Grace Dent's Christmas Quiz

    What are you – a festive curmudgeon or top of the tree?
    Nasa planning to build cloud cities in airships above Venus

    Nasa planning to build cloud cities in airships above Venus

    Planet’s surface is inhospitable to humans but 30 miles above it is almost perfect
    Surrounded by high-rise flats is a little house filled with Lebanon’s history - clocks, rifles, frogmen’s uniforms and colonial helmets

    Clocks, rifles, swords, frogmen’s uniforms

    Surrounded by high-rise flats is a little house filled with Lebanon’s history
    Return to Gaza: Four months on, the wounds left by Israel's bombardment have not yet healed

    Four months after the bombardment, Gaza’s wounds are yet to heal

    Kim Sengupta is reunited with a man whose plight mirrors the suffering of the Palestinian people
    Gastric surgery: Is it really the answer to the UK's obesity epidemic?

    Is gastric surgery really the answer to the UK's obesity epidemic?

    Critics argue that it’s crazy to operate on healthy people just to stop them eating
    Homeless Veterans appeal: Christmas charity auction Part 2 - now LIVE

    Homeless Veterans appeal: Christmas charity auction

    Bid on original art, or trips of a lifetime to Africa or the 'Corrie' set, and help Homeless Veterans
    Pantomime rings the changes to welcome autistic theatre-goers

    Autism-friendly theatre

    Pantomime leads the pack in quest to welcome all
    The week Hollywood got scared and had to grow up a bit

    The week Hollywood got scared and had to grow up a bit

    Sony suffered a chorus of disapproval after it withdrew 'The Interview', but it's not too late for it to take a stand, says Joan Smith
    From Widow Twankey to Mother Goose, how do the men who play panto dames get themselves ready for the performance of a lifetime?

    Panto dames: before and after

    From Widow Twankey to Mother Goose, how do the men who play panto dames get themselves ready for the performance of a lifetime?
    Thirties murder mystery novel is surprise runaway Christmas hit

    Thirties murder mystery novel is surprise runaway Christmas hit

    Booksellers say readers are turning away from dark modern thrillers and back to the golden age of crime writing
    Anne-Marie Huby: 'Charities deserve the best,' says founder of JustGiving

    Anne-Marie Huby: 'Charities deserve the best'

    Ten million of us have used the JustGiving website to donate to good causes. Its co-founder says that being dynamic is as important as being kind
    The botanist who hunts for giant trees at Kew Gardens

    The man who hunts giants

    A Kew Gardens botanist has found 25 new large tree species - and he's sure there are more out there