shurely a case for the men in white coats?

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From: 	[log in to unmask] on behalf of TERENCE SCHOFIELD
Sent: 	02 July 1998 21:25
To: 	[log in to unmask]
Subject: 	pcgs

Ahmad is right.
pcgs threaten primary care and general practice in many ways, but the changes 
are incremental and have been going on for twenty years.  We are now entering 
the final phase when general paractice will be deprofessionalised.  There has 
been a progressive weakening of ethical values.  General practice has been 
parasitized by a management structure which contributes nothing to its 
efficacy, increases non medical workload, diverts medical attention away from 
patients to bizarre financial arrangements which have no real business purpose 

other than to create jobs for bureaucrats.  These bureaucrats then expct to be 

paid out of savings from patient care and are prepared to bribe doctors to 
make the savings.  The doctors sometimes accept the bribes.   We are now told 
that the community or greater NHS interest should prevail over individual 
patients and some of the bureaucrats are suggesting that the ethical 
principles contained in the Hippocratic Oath and other charters should be 
abandoned in favour of the community's interests.   They tried that in pre war 

Germany with appalling consequences.   Will the role of the GP be reduced to 
explaining to the patient that his survival is not in the financial interest 
of the NHS and therefore there is a dichotomous choice of suffering or death?  

Will the legalisation of Euthanasia have to follow a system which places the 
community interest above the individual in medical decision making?  There is 
no community interest in sustaining the elderly , chronically sick or disabled 

in medical costs or pensions.  Doctors obey the law.  They did in Nazi 
Germany.   People who were fit went to labour camps, those not economically 
able were killed, not by the doctors, but nevertheless as a consequence of 
their following protocols devised by bureaucrats.   It is high time that 
patients were returned to the forefront of medical decision making and the 
ignorant and parasitic bureaucratic hangers on who feed like lice on the back 
of medical practice should be excluded from the process except for those 
administrative tasks to which no kind of clinical responsibility could be 
attached.  In the Bristol case, no effective action could have been taken 
against a non medically qualified chief executive.  All positions of 
responsibility for clinical activities should be filled by doctors.   It is 
unethical for a doctor to cooperate with any medical service where the doctor 
does not have clinical independence.(International Code of Medical Ethics)  
Protocols devised by some central body to which the government has input will 
be obeyed because there is likely to be manipulation of the GMCs rules to 
enforce compliance.   PCG finances will depend on compliance, and colleagues 
will suffer if doctors cause heavy expenditure.   Any doctor who denies proper 

advice or treatment on these grounds should be morally and legally liable for 
the consequences of his actions.  The doctors in pre war Germany cannot duck 
the responsibility for the consequences of their decisions.   I hear howls of 
protest at the analogy!   Look at some of the incremental changes in other 
legislation over the last few years, particularly the Crime and Disorder Bill, 

which effectively introduces "thought crime" and the Criminal Justice and 
Public Order Act 1994, to say nothing of the terms of the Police, Intelligence 

and Security Service Acts all of which bring up some uncomfortable parallels 
with pre war Germany and Stalin's Russia.  We can even use the "sneak line to 
denounce our colleagues to the KGB!"   Lets not get too complacent, chaps!
Terry  






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