David Misselbrook is a retired academic GP
The thesis of this book is simple. In our race to reform and “modernise” the delivery of healthcare we have become blind to much of what really matters. Dominated by managerialism and treating healthcare as an impersonal commodity, we have succumbed to a “Sort, Fix, or Send” model of practice. The paradox is that if we lose “care” from “healthcare”, we do not end up with “health”.
David Zigmond has had a remarkable career. Both an NHS GP and a Psychiatrist for 40 years he is well placed to reflect on the radical changes brought about by repeated unnavigated “reform” of the NHS.
There is now a significant academic literature on the importance of continuity of care, yet this seems to be largely ignored by the demands of managerialism and micromanagement in the modern NHS. But this book uses a very different methodology. Zigmond tells stories. He matches stories from the 1970s and 80s with stories from current experience. He recounts anonymised patient narratives in order demonstrate the importance of humanity in medicine. And how we have lost that humanity in recent times.
The obvious objection to his methodology is that maybe this appeals to nostalgia. But this would be a lazy claim. He is first to appreciate the genuine scientific and technical advances in medicine. But he systematically details how pastoral care has been lost within medical practice and why that matters.
It matters because the patient’s illness experience is not the same as the diseases that they suffer. This is not exactly news!
It matters because the patient’s illness experience is not the same as the diseases that they suffer. This is not exactly news! But Zigmond mercilessly describes the ways in which our healthcare systems have made us less able to listen to the patient’s experience, less able to see their experience in the context of their life, their family and their social circumstances. If we treat patients within a narrow biomedical model how can we truly help them as fellow humans? What do we have to offer for things that we can’t “fix”? How then can we offer humane support to those with chronic illness, to the elderly and the frail, to the dying?
It is likely to resonate strongly with experienced doctors – those who have travelled through the NHS’s chaotic changes.
Zigmond describes how this change has been accelerated as small stable units such as local GP practices and hospital teams, have been remorselessly degraded and replaced by large units with ever changing staff, suitable only to a factory model.
Zigmond’s narrative method is seductively effective – the book is an easy and engrossing read. But it is so much more than a heart cry as to what we have lost. It details how we have lost it and why it matters. It is likely to resonate strongly with experienced doctors – those who have travelled through the NHS’s chaotic changes. But it should really be read by younger doctors as it will offer a clearer analysis of our common dis-ease with the modern leaderless but over-managed NHS.
Of course, it should really be read by politicians, civil servants and managers. Well, we could all do worse than send a copy to our MP. I certainly shall.
Featured book: Zigmond D. Icarus Plummeting. Bath: Brown Dog Books, February 2026. http://www.davidzigmond.org.uk/icarus-plummeting-2/
Reviewer’s note: It is still possible to attend the launch of Icarus Plummeting at the RSM, Tuesday 17 February 2026, 6.30 pm. The event is free but booking is essential. Please email zigmond@jackireason.co.uk by 6th February 2026 to secure a place.
Featured image: Landscape with the Fall of Icarus, Pieter Bruegel the Elder (undated), Royal Museums of Fine Arts of Belgium, Bruxelles, Belgium, https://artsandculture.google.com/asset/6gGkgMwPyiEqUQ
