15 February 2007

Faith in medical professionals

Zoe Williams stirred up a bit of a hornets' nest among Guardian folk last week when she suggested that

in its total lack of foundation, its passion, and its unshakeable grip on the political and moral consensus, our faith in the NHS resembles nothing so much as our one-time faith in God.
Of course, as her article appeared in the Guardian, it barely questioned the principle of having a state medical monopoly, supposedly dispensing free health care to all who need it — while in practice severely rationing it. Williams confined herself to mildly musing whether people expect too much from the NHS, and tentatively hinted in the most pussyfooting way that perhaps doctors might be a teeny bit arrogant.

The comments from readers are, however, instructive. Some of the most vociferous complaints of the type "how dare you criticise the darling NHS" came from people who don't live in the UK. Take this one, for example, from BriscoRant:
I live in Australia ... a truly free health service is one thing Britain has left to be proud of. The medical system is based not on self-assessment, but on having a trained professional assess you. And for good reason. Probably they are a little calmer than you; they are trained in medicine; they are more objective than you about the signs and symptoms of your condition.

We recently had a great example — from the US — of self-prescribing. A little old lady got a bit worried about her health, so booked herself in for a full body CT scan, just as a check-up. The scan, of course, picked up some signs of ageing, and the radiologists report detailed these, particularly some narrowing of the coronary arteries. So the old dear took the report to her GP. The GP of course, having been notified of an abnormal finding, had to investigate it — more tests for the old dear, including angiogram and cardiologists fees. This confirmed, yes, there were abnormalities, but not at the stage where anyone would bother intervening. Those, Zoe, are the risks of self-assessment, and self-prescribing.
BriscoRant doesn't seem to have heard of the risks of assessment and prescribing when initiated by NHS professionals. E.g. the phenomenon whereby healthy people are placed under pressure to be screened, but where the results may be dangerously misleading.

There are other examples of touching (disturbing?) faith in the benevolence of NHS workers, rather confirming Williams's point. E.g. from Suraci:
The NHS in the UK is held in reverence I suspect because we know that if we get ill no amount of money will be spared to help us. ... When I woke up from a three day coma to find that concerned, supremely comforting and calming professionals had spent enormous sums of money keeping me alive without any suggestion I pay it back, I felt overwhemingly grateful to the NHS. We should give it up to the meddling of the Blairs of the world with extreme caution. They may not have our best interests at heart.
Some curious attitudes here. "No amount of money will be spared"? Er, I don't think so. "Overwhelmingly grateful" to people for applying funds which were confiscated from you to begin with? Of course Blair & Co. don't have your best interests at heart, but do doctors? These days, healthcare workers are explicitly told to take account of the needs of other patients competing for scarce resources. This now forms part of their "ethical" training, so it affects private practice as well as the NHS.

Similar spluttering from people with misplaced faith, or vested interests, can be found in the comments to Carol Sarler's suggestion in the Times that the GP "gatekeeper" system (the system whereby you can't get any serious medical product without your GP first giving approval) might be a waste of time.

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