Dr Nicholas Ramscar’s article was the winner of our clinical writing competition.
Politicians believe private medicine has the potential to save the NHS. I wonder if it can perform an even greater miracle – generating sympathy for a banker on the receiving end of expensive misinformation. Let’s see.
At a wedding recently, on a Greek island, I was sat opposite a wealthy expat in his early 30s. Originally British, he was working in Dubai for a US company. Between drags on his cigarette, he was telling the group how he liked to look after his health, by splashing cash on an annual two-day check-up at a North American hospital. At his last visit he had been offered the opportunity to tailor his physical examination, and as he was a heavy smoker – 30 to 40 a day – he had asked them to concentrate on his lungs.
Any GP in this country could have told him that his chest X-ray and examination would be normal, at least for the time being. At 30 he might be merrily sowing, but he wouldn’t be quite ready for the scythe yet. In private medicine though, minimal activity means minimal fees.
After a few words about the general dangers of smoking, the doctor auscultated and percussed, measured chest expansion and irradiated his customer. He pronounced himself satisfied that everything was normal, but was frank enough to say that his investigations so far didn’t give a full picture. For a little extra, his client could have one more test done, just to make sure that he really was uniquely impervious to the effects of tobacco.
The group at our table was made up of educated people – financiers and oil company executives. They were broadly approving of his responsible attitude to his health, and most had had similar check-ups.
They were interested to know the result of his test, and he was happy to give a good description of his spirometry. He’d been delighted with the discussion that followed and recounted his words, and the doctor’s, verbatim.
‘So I asked him what the print-out said. The doctor looked pleased and told me: “The lung function tests have all come back normal.”
‘”Normal?” I asked. And he said: “One-hundred per cent.” I was so relieved. And of course, I’ve carried on smoking.’
If an accurate representation of what he was told, this conversation represents the most high-ticket piece of bad advice I have ever heard. And here lies the rub of private medicine, competition and payment by activity.
This man was wealthy and educated – but not medically trained. He was no more qualified to see the absurdity of the service he bought than I would be able to run the finances of his company. He trusted the hospital to give him good advice and thorough investigation, although in fairness the clinic’s concern sounds exemplary – before he left, it had arranged next year’s appointment. With repeat spirometry added to the bill, to make sure nothing had changed.
Increasing private enterprise in healthcare will not improve its quality. The practice of medicine teaches tough lessons about the reliability of tests, the need to interpret them in context and the importance of applying experience.
People buying their care based on advertising brochures do not have the full facts or the hinterland of experience needed to interpret them. They are vulnerable to care that may be useless or downright dangerous.
Currently in the NHS, GPs have a vital role in regulating access to healthcare. Economics and ethics demand we do our best to limit unnecessary medicine, because even the most non-invasive test can cause indirect harm. Increasing competition and private enterprise will make this harder.
Dr Nicholas Ramscar is a GP registrar in Basingstoke