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At the heart of general practice since 1960

When Tony met Margaret...

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Conflict of interest alert: the first time I ever read an article by Margaret McCartney, I asked her to marry me.

I can't actually remember what the piece was about, and it doesn't matter. The point is, it was so relevant, resonant and rebellious that the only rational response was an immediate email demanding that she, er, drop everything and shack up with me.

So you might shudder to think exactly what effect a whole book – in this case, The Patient Paradox – might have on me. With good reason. That seminal Margaret moment was no flash in the pan. She has since proved to be a prolific and eloquent writer, one of a very small number of GPs – along with the likes of Mike Fitzpatrick and Des Spence – who have their feet planted in primary care but their eyes fixed on carefully reasoned iconoclasm.

And she does it awfully well, as regular readers of the BMJ, Vogue, FT Weekend and – most recently – Pulse will testify.

In The Patient Paradox, McCartney lines up a few of her least-favourite things and skewers them. Protocols, pharma, politicians and PR companies are all given a good roasting. In fact, the only thing beginning with ‘P' to survive unscathed is the patient – at least, patients genuinely in need of healthcare, because the underlying theme is that those most in need are those least likely to receive: ‘That's the paradox that I keep finding within the NHS: if you are ill, you may have to be persistent and determined to get help...yet if you are well you are at risk of being checked and screened into patienthood.'

Those familiar with the Inverse Care Law will know this isn't an entirely new idea.

But what McCartney perhaps lacks in originality she more than makes up for in sheer power of prose and weight of evidence. She's not averse to slaying sacred cows, either: ‘untouchables' like established screening programmes, and fun and finance-generating charities are ruthlessly dissected.

This is no opinion-based rant, though. McCartney is diligent enough to dig deep into the evidence, brave enough to name names where necessary and lucid enough to capture a concept in a memorable sentence, such as, ‘When you replace the doctor-patient relationship with a doctor-customer relationship, there is almost no point having a doctor in the equation'.

The book does have a flaw, though. It's not always completely clear who the author is pitching her ideas at - the medical profession or the lay public? With the former, she may well be preaching to the converted. With the latter, the contents may prove offputtingly dense, forensic or technical.

Which is ironic: while sexed up medicine, as McCartney points out, is bad for your health, an inadequately sexed up book may appeal only to patients so motivated that they understand all the issues already – a Reader's Paradox and, therefore a missed opportunity to get the message across to those who need to hear it.

She'd say that dumbing down to broaden her potential readership would betray her principles, whereas I'd say, do it anyway – which perhaps explain why, unlike Margaret, I'm rarely asked to write for The Guardian...

The brief clarion-call of an epilogue leaves us all on a high, though, with its plea for an apolitical, national sickness service uninfluenced by the likes of charities or Big Pharma. Unrealistic, perhaps, but nicely articulated. And we can dream, can't we?

Which reminds me, Margaret – that offer remains.

Dr Tony Copperfield is a GP in Essex

Readers' comments (1)

  • Mark Struthers

    As Tony says, Margaret's "not averse to slaying sacred cows, either: ‘untouchables' like established screening programmes, and fun and finance-generating charities are ruthlessly dissected."

    But not MMR! She'll have a go at silly cows like flu vaccine, but MMR is the sacred untouchable. Why? Look at the evidence,

    http://summaries.cochrane.org/CD004407/using-the-combined-vaccine-for-protection-of-children-against-measles-mumps-and-rubella

    Authors' conclusions: "The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate. The evidence of adverse events following immunisation with the MMR vaccine cannot be separated from its role in preventing the target diseases."

    That "MMR is safe" is rightly dubbed the "The Margaret Paradox".

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