Speaking to the director of a medium-sized company at a wedding last weekend, I had my attention drawn to another area where GPs are failing. We are not doing enough to prevent people taking unjustified sick days, and thus we are costing employers dearly. I half suspect that my new friend was a Department of Health stooge, because he used the dread phrase ‘perfectly placed’, as he explained why I, and not he, was responsible for making his workforce turn up.
We are not, and never will be, perfectly placed for this kind of policing. I wish I could change someone’s worldview in eight minutes, and make them dance into work the next day with a latte for the boss and a perfect Powerpoint presentation. But even with enough time, it simply isn’t my job, or yours, or any other GP’s. Our first duty is to the patient, not to their wider economic productivity. Of course, work is good for self-esteem, and having a role and a steady income is invaluable for health. We should avoid routinely signing people off for long periods with stress, unless there is good reason – but out of concern for our patients’ long-term health, not their employer’s wishes.
Similarly, we cannot be border guards (as recent headlines have suggested we should be), responsible for telling the authorities if we suspect a patient may be here illegally. There is strong emotive rhetoric that underlines the UK system’s status as a National Health Service, not an International Health Service. But a doctor’s first priority is the patient. Acting as a deputy for anybody who feels they have an economic interest in the patient, whether as employer or government, is not our remit. We are very far indeed from ‘perfectly placed’ for this kind of enforcement work. A dangerous conflict of interest arises the moment we are forced to water down our advocacy for our patient, and accept responsibility for the interests of external third parties.