This is an interesting discussion on privatised medicine – something that many commentators are writing about. There is no doubt that the recent NHS reforms has opened the door to private companies in a way that is unprecedented. Under the guise of efficiency and competition, private providers are being given contracts for huge aspects of NHS provision. I think it is important that we don’t loose sight of the fundamental values of the NHS. The government claims that so long as care remains free at the point of delivery then it matters little as to who delivers that care. I beg to differ and will expand on that in a separate blog. In the meantime, read this interesting letter which was published in the BMJ.
Private medicine’s real manifesto
BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4188 (Published 1 July 2013)
Cite this as: BMJ 2013;347:f4188
- Liam Farrell, retired general practitioner, Crossmaglen, County Armagh
Historians may one day look back and say that there was a time, in the 20th century, when people actually cared about each other. That once the world was more than just a jungle—full of monsters rising on all sides to smite us, where the strong prosper and the weak are devoured.
But that time is passing, as our health minister perfects the trick of throwing up his hands in horror while simultaneously washing them, like a little Tory Pontius Pilate. And as the NHS is slowly eroded, private medicine is blossoming. It even has a conference now: Private Practice 2013 is “for clinicians looking to launch or expand their private practice” and who “want to start a private practice and offer a higher quality service.” So it’s timely to present the real manifesto for private medicine.
- 1) Always remember that you are a client, not a patient. Your main purpose is for us to generate income. Our doctors will be professional, I’m sure, but if you do happen to get better, that’s just a bonus.
- 2) Health is a commodity, disease the product line, and doctors the sales force. We’ll obfuscate with weasel words like “providing a better service,” but remember point 1.
- 3) We do things to you; that’s what we do. There is money in procedures. Sitting you in a bed and watching you for a few days is not a big earner. Masterly inactivity will not launch us into the million dollar club.
- 4) Old, chronically ill, or mentally ill people are unsuitable for our services.
- 5) Private health screens are the whores of medicine. They make even us a bit ashamed.
- 6) “Robes and furred gowns hide all / Plate sin with gold, / And the strong lance of justice hurtless breaks.” * We disguise our mendacity with a veneer of luxury. The waiting room has carpet and ferns; the whorehouse parlour look is quite deliberate, and you won’t have to share it with the riff raff. In contrast, the NHS has always been the Ryanair health service—austere, without frills, it doesn’t aim to give you what you want but what you need.
- 7) Of course, if the worst happens and you get really sick (or unprofitable) you will be turfed back to the NHS. Looking after sick people: that’s what it’s for, isn’t it?
* [Had to Ixquick/google this one, but you likely remember your King Lear much better than me.
Those of you who want to be enticed into reading Richard Bentall’s book should listen to this short podcast produced by the BBC. I came across it by chance but it is story that is also described by Bentall. It relates to the Rosenhan experiment, named after the research who investigated the way in which people get labelled as mentally ill. Rosenhan died earlier this year and the BBC produced a short podcast to commemorate the significance of his work. You must listen to. Here is the link
Look a the June 5th 2012 episode: The Rosenhan Experiment. A must for every student of psychiatry.
It will not have escaped your attention that the NHS is undergoing significant reforms. You may think that what is happening is irrelevant, but it is going to impact on the type of health service you will be working in. Whilst you don’t need to know the detail (trust me it is really boring and there is a lot of jargon to understand), it is instructive to see how the debate is being constructed. I’ve posted two tweets citing articles from Ben Goldacre who writes the Bad Science column in The Guardian. He makes some interesting points about the selective use of statistics by government ministers. Check out the editorial in the BMJ that he refers to as well.
The incident that I will reflect on involved a prescribing error in a 20 year old male psychiatric in- patient. He was being treated for a respiratory tract infection by me at a mental health hospital general clinic. The patient had a history of sleep and wake apnoea, severe obesity and schizophrenia (for which he was currently taking clozapine).
I had initially prescribed amoxicillin for his infection but this had been ineffective. When I saw him a week later, he was still not better and I decided to prescribe erythromycin as a second line treatment (erythromycin and clozapine in fact dangerously interact to increase the risk of seizures). My mistake had been noticed by an auxiliary nurse also present at the clinic, but she had not raised this concern at the time (after all, I am a Professor and I must have known what I was doing!). Only two days later when my colleague was reviewing the patient did the nurse reluctantly point out the error. Interestingly, even the hospital pharmacist who was dispensing the medication failed to pick up the error.
One of my research interests is patient safety in primary care. Patient safety incidents are an important and widespread problem in primary care. If we use a common definition of a patient safety incident (any unintended or unexpected incident which could have or did lead to harm for one or more patients) then evidence from the literature suggests that potentially there could be anywhere between 37-600 patient safety incidents per day in the NHS). Fortunately, most of these incidents will have very little consequence – they could be errors of process, for example, a misfiled result, a missing discharge letter from hospital. They could be errors of omission, for example a patient who should be on a drug but isn’t. Or they might be something more serious such as a delayed diagnosis or even a misdiagnosis which may result in harm.
The point is that many things can go wrong in general practice and some of them may have serious consequences. Trying to improve patient safety can be fraught with difficulty. Where does one start?
When things go wrong, there is a tendency to blame people. However, our understanding of patient safety shows us that quick assumptions and routine assignment of individual blame do not get to the heart of the problem. There are many underlying causes which contribute to patient safety problems and in the majority of cases these extend beyond the individual or the team.
To show you what I mean by this, I am going to tell you about a patient safety incident that involved me. Yes, just like anyone else, I can make mistakes and sometimes those mistakes can have serious consequences. The important thing is to be open about what has happened, understand why it happened and make sure that learning takes place…..
(My thanks to my medical student, Javed Naqvi, from UCL who wrote up this incident)
This is the edited text of a speech that I gave to graduating medical students in July 2010. Many have asked for a copy so here it is….
Three years ago I stood in front of an audience similar to this and my message was one of optimism. We had never had it so good. The University had completed a major capital building programme, our merger had been hugely successful and our graduates were entering a world where their skills were highly sought after.
Yet in the space of a few years everything has turned upside down. Although you are protected as graduating medical students, your colleagues in other disciplines are entering an external environment where graduate unemployment has been the highest for over 20 years. We as an institution are facing cuts of at least 25% form one of our main funding sources. Many of you will have read that it is likely that tuition fees may rise to levels that will make it very difficult for you to consider a University education for future generations – perhaps even putting studying for degrees like medicine out of the reach of everyone except the richest. I am sure that all of you feel that we face an uncertain future.