Ahmad wrote
>It is a case of refusing collusion.
>I reckon I spend about half of my consultation time trying to:
>a) temper expectation
>b) marry what is *possible* and *feasable* with what is best for the
>well being of my patient
>c) not to collude with cultural expectations of what is not possible
>d) not to nurture unrealistic demands on me and on the system as a
>whole
>e) tell people it's OK to cross the road and it's just snot that will
>go away by itself, don't expect me to wipe for you!
This is me too. There is a difference between patient centred
and patient immature or patient inappropriate or patient
unreasonable.
>It's not really a case of Risk econo-centred model. It is a case of
>getting real. After all, somebody has to pay for health care. So
>far, that somebody's been the taxpayer and the doctor who can not
>and will not say no. The former has been saying: "I won't pay but I
>want everything" for decades, and the latter still says: "I will
>work more for less 'coz I am really a nice guy".
I cannot quite find a principal in "getting real". It sounds too much
like a value judgement - presumably Ahmad's view of reality. My
contribution to "getting real" while the life of the NHS moved
peacefully towards its close was to become a first wave fundholder
and now a total purchaser. Please don't tell me it won't solve
the problems. I know that. But it raises the hope of evolution to
the next level rather than a more chaotic transition.
>Well, my esteemed Doug, the here and now is a health system that is
>cracking up with collapsing A&E, beds blocked with elderly patients
>who can't be discharged to nursing homes, more and more secondary
>work being dumped on the cheapest professional labour in the land,
>hospital closures, dump in the community, rhetoric stolen from Mao,
> gp training schemes that go begging for takers across the globe,
>consultants who are too scared of the power suits that they became
>impotent, nurses who are paid in monkey nuts and being asked to take
>on more, politicians who lie through the teeth and inhabit some
>weird planet yet to be discovered by the SS Enterprise.
>Culture? Don't talk to me about culture when a lot of what I see
>around me is despair and we have not the guts to speak out.
Culture is what prevails currently. We are in the middle of a
revolution, so of course many things seem desperate because we cannot
see the end point, and so far all revolutions have been painful
for most people I think.
>Yeah, let's do everything for everybody all of the time and get it
>over and done with. Eventually, the cleaning lady from RSA will
>come along, pull the plug and finish her song.
>And guess what? We will still be under the anaesthetic!
And when we come round the game of life will still be being played.
Doug Jenkinson, Keyworth, Nottingham.
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