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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. %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%