Early research into the Doctor-Patient relationship and the concept of 'trust'.Have a look at this abstract from the illustrious New England Journal of Medicine, which is not exactly known for it's pro 'socialised medicine' editorial policy. It looks at the concept of 'gaming' to hit targets in order to achieve financial gain - i.e the New Labouresque tactic of removing people from the statistical count if the don't conform to your targets.
Conclusions - Exception reporting brings substantial benefits to pay-for-performance programs, providing that the process is used appropriately. In England, rates of exception reporting have generally been low, with little evidence of widespread gaming.
So if we're not defrauding the system, and we're not playing golf all the time, then what the fuck are we actually doing?
It's obvious that he government and 'liberal-elite' chattering classes don't trust GPs, despite the fact that that our patients do. This article is as about as hard as the evidence gets, and shows that GPs are not systematically cheating to earn money - we are actually hitting these targets, and that the patients are the one's benefiting as a result. If someone can provide me with evidence that something similar has happened, in anything other than the most heavily regulated, free market system I'd be quite interested. Now fuck off Toynbee, here's a good girl....
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Unfortunately the government won't allow the facts to get in the way of any story they might want to tell about GPs on the make.
The concept that GPs might actually be honest and altruistic is not one they have any familiarity with.
As a patient, I used to trust my GP with my life. Bad game plan. My brain got buggered up for several years from the cerebral oedema that he actually diagnosed but totally failed to treat.
OK, he may be the one rotten apple in a big barrel, but his neglect caused massive destruction in my life in every way you can possibly think of. So, my game plan is to expect GPs to earn my trust now.
I now have a lovely young GP, first appointment and bright-eyed etc. But I see her struggling with the abysmal PCT/other NHS systems. Even though I intuit that she's an honest and even compassionate person, the NHS does not allow her to be. And she doesn't want to rock the boat: her new career is tenuous and she's obviously feeling a tad insecure (I mean, she needs me to call her Dr Lovely Young Woman when she makes so free with my first name...I wasn't quick enough to say, 'Ok then, that's fine, IF you call me Dr Acle...' Tch.)
We're in a new age. The half-baked policies of successive gvts have ensured that respect for ALL our fellow human beings has been eroded - and that no expert can be fully trusted. Divide and conquer.
Trust is the sine qua non of society. Respect oils the wheels. NuLabor spin and misrule have written off the whole cart I'm afraid.
So, my game plan is to expect GPs to earn my trust now.
That's sensible. Unfortunately personal doctoring, where you can get to know and trust a GP, is going to disappear if the Government gets its way.
FWIW I call patients by their proper title until asked to use their Christian name, but to be honest I rarely need to address them by name at all during consultations.
Dr Brown...thanks for your take on the situation.
The loss of personal doctoring has happened in my neck of the woods. It's a massive loss to everyone. Where's the job satisfaction in seeing an endless stream of patients whom you don't really know and whom you're never going to get to know and understand? It can only impact badly on quality for all concerned.
And this NuLab gvt is entirely responsible.
From a patient's perspective it's reassuring to be named, though not in a way that indicates a doctor's trying to bolster their own ego/insecurities at one's expense.
I feel all this stuff is part of a wider malaise that's infected this country. I fear we've rather gone past the point of no return now.
I thought what happened in relation to these targets was:
1. Government thinks doctors are all eeeeevil
2. Government imposes a set of hoops to jump through, with financial incentives, to get the doctors to do what is right for the patient.
3. The doctors are already doing what is right for their patients, within the constraints of the system, and therefore easily jump through all of the hoops. All they needed to do is a bit more paperwork.
4. Government sees all of its targets met, it also sees not much change in quality of care (since the doctors were already actually doing what their patients needed without any intervention from government). Government and its supporters therefore conclude that the doctors are gaming the system.
Chris
The other day I noted on a blog called 'Burning Our Money' that the 'productivity' of the NHS has diminished over time, despite all the added £billions.
The fact of the matter is that Targets Do Not Work. (See surgeon John Riddington Young's recently published book for doctors' view on the whole shambles).
Targets cannot possibly measure the most important things.
But the gvt and its adherents just cannot bring themselves to face up to the reality that their 'management' is at fault. So, of course, they witchhunt. Sadly, doctors and other clinical staff get bound to the stake. The first premise of the Stasi culture of which Mr Riddington Young speaks is 'divide and conquer': the gvt has set up a medics v patients syndrome where none of us wanted or had any cause for it. Doctors cannot possibly deliver the healthcare they want to under this targetoid 'management' regime.
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