For me the answer comes from George Bush — not Dubya but his Dad. Serious students of politics will remember his famous remark during the 1992 Election Campaign. He said that he wanted American families to be more like The Waltons than The Simpsons. He went on to lose that election to Bill Clinton and The Simpsons has become one of the most popular TV programmes ever made, although commentators disagree on how much the two events are related.
Since then he has been much mocked for the quote, but I suspect deep down a lot of us long for that ordered and squeaky clean world. A world where each day ends with a comforting round of ‘Goodnight John Boy’, ‘Good night Mary-Ellen’ and soothing music. TV programmes about parenting and achieving the ideal Happy Family are taking over from cookery and makeover programmes. I think that Dame Janet Smith was showing the same yearning for order and predictability during her investigation into the Shipman affair. One of her recommendations was for medical students to be weeded out of the profession if they ‘fail to show they recognise the importance of ethical standards’. She wants tests to ensure that students ‘have absorbed the ethical principles that should govern their career’, a rather naïve view of the ability of tests to peer into people's souls.
But deep down we also know the world isn't like that and despite being ostensibly a children's cartoon populated with garish yellow people, The Simpsons is closer to real life than the sugary Waltons. In Springfield the world is more chaotic and confusing. It is a place where people mess up regularly and ‘DOH!’ has become Homer Simpson's catch phrase as he blunders yet again. What George Bush didn't seem to realise though is that it is more than an anarchic thumbing of the nose at respectable families. It shows flawed people making mistakes and acting from mixed motives, muddling along but still together as a family, still loving each other and often landing up doing the best they can in difficult circumstances.
Oh yes — the Back Pages — well to me they are the Springfield to The Walton's mountain of academic medicine and managerial health care. A refuge for people who suspect that even if we woke up one day on medicine's Walton mountain — where empowered patients, all with cholesterols of 3.9, made fully risk-assessed journeys along patient-centred, perfectly swept pathways to extensively revalidated, washed behind the ears doctors, hair neatly brushed and working from evidence-based protocols with perfect communication skills — before lunch something would come from leftfield to make us shout ‘Doh!’.
But the Back Pages, like The Simpsons, are not just about thumbing the nose at starchy academia. They regularly bring a depth of wisdom and experience and a wealth of cultural insight which helps to flesh out the dry bones of academic medicine and an occasional reality check to some of its received wisdom. They can also be pragmatic and a reminder that sometimes we have to accept being good enough as doctors and not always expect perfection. They are not just about shrugging the shoulders and giving in to the complexity of the real world of medicine but about making our way in it as humans and not just as clinical scientists.
I suspect that even in the rarefied heights of the health service's HQ in Whitehall, the inner sanctum of management macht frei, they understand this. Despite the spin promising control and stability through targets, mission statements and overblown initiatives they know the world is darker and untamed. Perhaps I'm being fanciful, but just type Homer's catchphrase into Google and see what comes up.