The World Congress on Lung Health had physicians from about 60 countries represented. These are opportunities for me to get an overview of medicine as it is practiced throughout the world.
A physician at the Congress from the United Kingdom stated that he is very unhappy with his medical practice in the National Health Service (NHS). He felt that everyone he knew was unhappy with their practice and the bureaucracy associated with it. He is looking forward to retiring, when other sources of income materialize, and felt that most physicians he knew are looking towards almost any opportunity to retire or even work in a non-physician capacity.
A physician from Finland stated that he is currently working in Norway, which pays the highest salaries in Scandinavia. The government there is more wealthy due to oil revenues and thus are paying doctors better. This shouldn’t surprise us since we are seeing doctors uproot their families and practice for a temporary better deal in many states in our country.
A doctor from South America stated that he no longer can afford to buy medical textbooks or belong to medical societies. He said he is expected to work longer hours with no increase in his government wage. Sound familiar? Seems like we were able to de-professionalize ourselves without the help of government medicine. No wonder socialized medicine doesn’t sound so bad to many of the new generation of American doctors. We’re almost there.
Hospital Doctor, subtitled as “21 years as the leading newspaper for all hospital doctors,” reported that the “consultants” (hospital doctors) in the National Health Service will not receive the promised intensity payments in their pay packets because the British Medical Association is unable to reach an agreement with the government on how the money should be allocated. It seems the government wants to allocate the money as a reward for consultants’ workload and job intensity, while the BMA wants it distributed equally to all consultants rather than on how hard they are working.
On reading the above report, Peter McDonald, a consultant surgeon, stated, “I felt something snap within me. With my loyalties to the NHS for more than three decades repaid by lies, I know I am not alone in feeling repulsion in the way doctors are being portrayed by our masters and the media.” He points out that some consultants have been on call every third day for 16 years. His own hospital received a fine for having the longest waits on trolleys (gurneys). The business manager was asked to stay within budget. So he destroyed (closed?) a ward. It had the desired effect. Money was saved; nurses drifted off into other activities or took retirement, and the budget was balanced. McDonald feels that with the crises in nursing and ancillary staff, the NHS is in danger. Will doctors be the next to leave? For the first time he is contemplating leaving the NHS.
Meanwhile another issue is headlined: “BLACKMAIL” – Government tells medical profession: Do it our way or else. The Government feels that some doctors in the NHS are devoting too much time to private practice. New consultants are expected to accept a ban on private practice for at least seven years to ensure proper management of their time. This is to reduce the maximum wait to four hours for emergencies, three months for an outpatient appointment and six months for an operation. Prime Minister Tony Blair said, “Though most consultants work extremely hard for the NHS, beyond their contractual commitments, there is no proper management of their time.”
NHS spending is scheduled to rise £15 billion over the next three years, according to Chancellor Gordon Brown. This includes £300 million from duty on cigarettes. It seems that more doctors are coming at cross currents with paradoxical health issues. “Dear Patient: Please smoke more so that there will be more tax money to pay me a better salary so that I can treat your cigarette-induced disease in greater comfort.” Although it may be legal, it is always unethical to ever accept tax money from the diseases we are trying to treat. Doctors should always have a higher code of ethics than politicians.
In a debate on whether self-regulation for doctors should be ditched, Dr David Starkey argues that the whole arrangement of professional self-regulation is justified in terms of an independent profession, devoted to the welfare of the patient. However, in the modern NHS, medicine is no longer a profession. Doctors are, for the most part, salaried employees and rationers of health care, which means they cannot put the concerns of the patient first. It is impossible to advocate for the patient and manage budgets. He feels there is evidence of rapidly declining standards of health care in the UK compared to the rest of the world. He also feels that the approach of New Labour, with its standard-setting and targets, is only worsening the problem, and the form-filling will eat up even more of the doctor’s time – time they could have spent caring for patients. The solution, as Starkey sees it, is for patients to fund much of their health care privately, empowering themselves to demand the best service from their doctors.
Dr Tony Copperfield, a GP practicing in Essex, comments on how rationing in health care is suddenly becoming a hot potato. But, he states, rationing is nothing new. “Waiting lists for surgery effectively ration operations – by the time that my patients reach the head of the queue for hip replacements or cataract extractions, they are, invariably, dead.” Copperfield goes on to explain that they will demonstrate a better sense of priority than the Americans. He cites, “In the infamous Oregon experiment, the US public apparently rated breast augmentation more important than plating a fractured femur. A generation of full-breasted American females will soon be walking with a limp.” He feels rationing helps restore a sense of perspective. “Patients should be limited to a seven-minute GP consultation, two problems per attendance, and a maximum of four consultations and one home visit per year.” He further feels that prescribing could also be rationed: “No more than three courses of antibiotics per patient per year.”
The Sunday Telegraph reported that, with the NHS waiting lists growing and the cost of medical coverage insurance seriously damaging one’s wealth, more people than ever now opt for pay-as-you-need health care. The journalist, Emma Simon, lists the cost of private treatment, e.g., hysterectomy for £2,300 to £4,300 and hernia for £895 to £2,025, as cheaper than the cost of health insurance. Hospitals are now providing loan facilities, but these require customers to repay the debt in 12 months. A new concern, Go Private, charges £18 per year per household and will pay your medical bill and then finance the actual costs for you. It is suggested that patients shop around for the best treatment for their money and then finance costs as they occur if they need to. Go Private says their service empowers patients to look after their own medical care.
The Queen expressed her regrets that Madonna, who lives in England, felt the National Health Service was so Victorian that she had her baby in Los Angeles. However, the press expressed their approval that, since she could afford private care, this allowed those who needed the NHS to obtain care.
In the two weeks that I had the occasion to review the newspapers, I noted in the British papers (unfortunately, I couldn’t read the ones in the other languages) hundreds of stories of unrest in the National Health Service. Talking with doctors from the various countries basically revealed the same story. It seems that we are at the crossroads in medicine in this country. Can we learn from the British and the world experience? Wouldn’t it be better to build on the private insurance and cash system we now have, rather than go down the road of further government medicine. Other countries, which have national health plans, are making desperate attempts to re-institute health insurance or even pay cash and finance health care after the fact? If you would like to participate in a dialogue on this subject, please send me an email.