Mary Poppins no longer has the answers in medicine – for either doctor or patient 

It is said that when Robert Sherman sat down to write ‘A Spoonful of Sugar’ he was inspired by his children’s tale of being given their polio vaccine on a sugar cube.

The iconic song from Mary Poppins, lyrically captures a moment in time when the relationship between society, medicine and research was a more unquestioning and optimistic one. In such a state we all propped one another up with convenient folklore: all medicine is good for you it just needs to be sweetened to make it more palatable.  A suppliant population served medicine well, just as an over-confident profession let the population off from asking questions.

But now, over half a century later and after years of sugar-coated pills and doctors being given sweeteners by industry – this settlement is unravelling. Such is the level of concern at the fractious relationship that now exists, that the Chief Medical Officer, Professor Dame Sally Davies, last year knocked on the door of the Academy of Medical Sciences (AMS) for help.

What worries her most, she said, is the sense that society neither trusts its doctors to prescribe drugs appropriately; nor researchers to develop the evidence in an unbiased fashion. ‘How can we hope to improve the public’s  health if the public see less and less reason to believe us?’ is the underlying message.

The Academy is now undertaking an inquiry into how society can best use evidence to judge the benefits and risks of medicine. It is looking at a range of issues – from research methods to conflicts of interest and media reporting of medicines. I am a member of the inquiry along with Suzie Shepherd from the Royal College of Physicians Patient Network. A public dialogue exercise is planned later this year.

These activities will be important. But it occurs to me that the real task ahead is for us all to embrace that which currently seems most threatening. To encourage patients to ask more questions of their doctors and doctors to do the same of their patients. To turn the surgery into a place of shared inquiry where patient and doctor set out to search and understand the evidence together. It should not be to shore up the traditions and disciplines of yesteryear but to refute the sentiment that underlies them – as expressed in the song ‘The Life I Lead:’

Tradition, discipline, and rules must be the tools
Without them…Disorder! Chaos! Moral disintegration!
In short, you have a ghastly mess!

I seem to remember that when Mary Poppins is challenged she  famously replies, ‘I don’t explain anything.’ So it is that until now too many doctors have shown no inclination to explain to patients what they need to know. While those that do, tell me they do not have the time to do it as well as they would like.

In the meantime, patients lack the sort of informatiom presented in a way which will help them ask the right questions. As well as the support to help them make the right decisions for themselves and their family.  And yet, and yet, we could also assume greater personal responsibility for knowing ourselves and our health than relying on hearsay and folklore whether passed on by Disney or anyone else. To not be distracted by the whistling of a happy tune.

It’s a brave person or organisation that attempts to take Mary Poppins down. Even when she has been weakened by a sugar tax.

But it should be evidence, in the end, that we look for to help the medicine go down.

One thought on “Mary Poppins no longer has the answers in medicine – for either doctor or patient 

  1. I agree wholeheartedly. My experience of meetings with GPs has been they were anything but ‘consultations’. They need educating, not for their medical prowess but to know how the develop an enquiry. However, patients, too, need to be educated to use questions, especially open-ended ones that will develop enquiry. Do secondary schools promote such dialogue, not just English lessons but in all encounters with pupils?

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