Skip to main content

Distributed for Intellect Ltd

Fighting for the Soul of General Practice

The Algorithm Will See You Now

An argument for attentive and personal care within the bureaucracy of health care systems.

In Fighting for the Soul of General Practice, two practicing doctors share their experiences of working within the underfunded and highly bureaucratic health system in the United Kingdom. Drawing on years of experience treating a wide range of patients from all backgrounds, they show what is lost when regulation overrules relationships, standard practice eliminates discretion, and algorithms displace personal attention. While acknowledging that bureaucracy is inevitable and important, they argue for an approach to medicine that is about creating meaning for doctor and patient and that privileges connection, attention, and care within each encounter.
 

258 pages | 15 halftones | 5 3/4 x 8 1/4 | © 2023

Global Health Humanities

Medicine


Intellect Ltd image

View all books from Intellect Ltd

Reviews

“Drs. Shah and Foell lay out a diagnosis of what is wrong in the contemporary practice of medicine: excessive protocols, productivity measures, digitalization, and restrictive algorithms that come between the humanity of the physician and the humanity of the patient. When doctors become “street-level bureaucrats” (38) their allegiances are torn between doing what the institution demands and what the patient needs. This is truly a loss of soul for both physician (leading to burnout, compassion fatigue, and moral injury) and for the patient (dehumanization, de-individualization, and being processed and protocolized). Although the authors work in the National Health Service (NHS) in the UK, their vignettes resonate with doctors in the US dealing with fragmentation of care, layers of bureaucracy, and prior authorization with insurance companies, while working in large institutional healthcare systems.

The authors give numerous clinical vignettes that illustrate the tensions between institutional medicine and individualized care. Their prescription for healing is found in their attention to the stories of their patients; their own stories of resistance by sneaking healing back into medicine through “micro-breaches” (194) of generosity within the institutional machine; and their work to connect to the full humanity of themselves and share that with the full humanity of patients.

Drs. Shah and Foell give us hope for practice within institutional settings by reminding us to always search for the story and soul of healing in medicine, so that we can be good human beings as well as good technicians and protocol managers.”

David Kopacz

“With increasing bureaucracy, doctors struggle to take the life pressure [sic] of their patients. This book offers a compelling reflection on the importance of listening to patient stories as opposed to applying chilly algorithms for human care. The authors provide the reader with a lively under-the-rug inspection of street-level medical practice and the turbulent business of managing through bureaucratic demands.”
 

Paul Crawford, University of Nottingham, UK

“UK general practice is at a precarious crossroads. This book captures the essence of traditional, relationship-based, family doctor care, which is now under threat from a number of forces—not least the technologization of medicine and the inexorable encroachment of algorithmic, if-then decision-making on relational and narrative-based clinical method. At the very least, Shah and Foell have documented the essence of what we risk losing. Perhaps, if their warnings are heeded, they will also succeed in retaining and restoring what they rightly describe as general practice’s “soul.”″
 

Trish Greenhalgh

Table of Contents

List of Figures
Acknowledgements
Prologue

Introduction: Standardising General Practice

1. Weaponized Bureaucracy: Bureaucracy as a Source of Injustice
2. Pigeonholes: Medical Categories
3. Guidelines, Tramlines, Mindlines: Interpreting the Evidence
4. Waiting to Connect: Algorithms That Dictate Access
5. Taking Liberties: Regulating the Mental Health Act
6. Passports for Passing: The Bureaucracy of Death
7. A Labour of Love: Why It Is That General Practice Is Still a Good Place to Work
8. Final Reflection – Image Reviewing

Conclusion
Bibliography
Index


A Labour of Love -a few stories to end, of healthcare enacted with love

Be the first to know

Get the latest updates on new releases, special offers, and media highlights when you subscribe to our email lists!

Sign up here for updates about the Press