“Dad, you've got an earring!” She gazed at the photo of me from the mid-1980s. “At least I'm not wearing make up,” I said defensively, but this only made her eyes narrow more. I'm no baby boomer and, according to Wikipedia, I am part of “Generation X.” Clearly Generation X smacks of the school geek coming to the Christmas party in a pair of sunglasses—tiresome, unimaginative, and just plain dumb. But with the new look BMJ comes our turn to shape the medical agenda.
What of the baby boomers? It is foolish to make sweeping generalisations, but let's not let reason get in the way of an argument. This postwar generation has held sway over our political and medical lives for the last decade and will do so for a few more to come. Spawned on postwar optimism, shaped in the heady 1950s and 1960s, they are a huge, glimmering shoal. The baby boomers have a sense of certainty and self confidence like no others. But certainty is concrete—strong, but ugly and brittle. The mantra that money and resources will “cure it all” has defined their tenure, with polypharmacy to modify all manner of medical risk, a “need to screen,” and, most of all, a need to intervene. Contrary to popular perception, unfortunately, screening and treating both paradoxically deliver little benefit to the individual. More medicine, money, and meddling are an unholy trinity.
Will we Generation X-ers be any different? We had the 1970s and 1980s, with their social unrest, unemployment, and the rise of the cult of the individual. We are a small generation, with many of us coloured by an insecure childhood. We are uncertain about marriage, worried about children, fearful of commitment, and unsure of roles in society. What will happen on our watch? Will we see some form of euthanasia? Will medicine turn its energies to the developing world? Will we see a backlash against thoughtless obsession with intervention? Will we see a halt to the relentless obsession with specialisation and value once again the role of the generalist?
We do have one duty, however—to be the fearless guardians of the NHS. The NHS, with all its faults, has provided equity and has integrated, high quality care like nowhere else. We have been spared the excesses of fee for service systems, with their inherent financial conflicts of interest. Bear witness to the distorted health care elsewhere in the developed world. We should look back to the founding values of the NHS—vocation, duty, continuity, commitment, and—most of all—community. We must also look forward, for our time is now.
The 1980s are back, my daughter likes big hair, plastic jewellery, and stretch jeans, and she gave me a small pencil as a Christmas present this year. “What's this,” I said. “Guyliner,” she smiled.