This posting is brought about by the random association of some
events this week - in particular, Peter Johnson's tale ('Quality??'),
the disgruntled comments of one of my partners, and Iain Hotchkiss'
column in the weekly rag, which seemed even more gloomy than ever
(commiserations if you'd had a bad week, Iain ;)).
To start with, I feel that there can be no justification for what
happened to Peter and his family, though we've only heard one side of
the story - having been on the receiving end of patient complaints
alleging horrendous callousness on my part, which have then proved to
be quite unsubstantiated, I feel I have to attach that caveat!
However - any I don't say this in an attempt to excuse what happened
- such incidents are vastly outnumbered by those in which patients
treat us in an unreasonable manner. There have been occasions when I
have spoken to patients in a regrettable manner, and (as far as I can
remember) I have always apologised afterwards - I don't recall any
apologies from patients after they have spoken to me in such a
manner. Peter's comment that public sympathy for GPs is wearing very
thin is probably true, and is worrying - any profession, be it
medicine, law or window-cleaning, which allows the relationship
between those who practise it and those who use it to deteriorate to
this level is in serious trouble.
One of my partners spent some time this week telling me about why he
was groing increasingly disillusioned with the profession, a feeling
that seems to be mirrored in some of the postings to GP-UK, and in
the correspondence columns of just about every medical publication.
It seems to me that we have allowed ourselves to be caught between
two mutually exclusive positions. One the one hand, we can provide
the 'traditional' type of general practice care, with sympathetic,
considerate GPs for whom nothing is too much trouble, who are always
there, and are at the heart of their communities; or we can provide a
consumer-oriented service, responding to the demands (which may be
rather different from the needs) of the patients (or clients, as I
expect we will be required to call them in future). It suits
politicians pf all complexions to have us in this position, as they
can get something approaching a consumer-oriented service for the
cost of the more traditional service, but it suits no-one else,
certainly not us.
There was a very thoughtful letter in the BMJ a couple of years back
from a retiring GP who commented that, when he joined the profession,
he was told that he could expect about one professional complaint in
his career, would earn more than his solicitor, and could practise
medicine in a climate in which violence against GPs was unheard of.
The letter-writer went on to ask how we had allowed our leadership to
let the current state of affairs arise, in a cmparatively short time.
I would suggest that he looked no further than some of the
pronouncements of the BMA in recent times; long after fundholding
became a fact of life for many of us, the BMA has continued to fight
a battle that was lost in 1990, rather than finding a battle that it
might win. For example, whatever its weaknesses, fundolding has
allowed us to put a price on providing a decent level of care for our
patients - we could all use the prices provided by our local trusts
to calculate how much we need to get everyone the operations,
appointments, etc, that they need, and could then present the
politicians and the public with the bill - after that, we would be in
a position to say to them that the level of service they get is the
level of service they are prepared to pay for. Instead, we have
allowed politicians to divide us into factions promoting or opposing
fundholding, community-based purchasing, etc etc etc.
Like many of my colleagues, I too have grown disillusioned with a
system that fails my patients and fails me. Should a decent
opportunity arise in another field, I will take it. I expect many
others will too (as Iain suggests in his precent posting about M&S),
and the politicians (and the public) will be left with an
impoverished service.
Apologies for the length of this.
Prit Buttar
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