Thursday, 26 November 2009

Money well spent?

I had an unusual consultation this week with a man in his 40's who has extremely poorly controlled diabetes. He seemed rather sheepish throughout, with his shoulders hunched, fidgeting nervously. It was clear that there was something he was ashamed of. Eventually it came out. To my surprise it wasn't anything to do with a fetish for cream cakes or an inability to steer clear of deep fried mars bars, as I had been expecting. Instead, it was the furtive admission that he was seeing a private specialist.

Shock and horror. Imagine my fury at this blatant betrayal of the NHS. He began to spurt excuses that it was only because he had insurance through work and so he thought he 'might as well use it'. He was upset, and clearly felt that he had somehow been disloyal. I was amused to see that he seemed genuinely surprised when I explained that I was not in fact hurt by this revelation. Instead, this piece of news meant that I would be getting speedy help in managing a complicated patient, and I was delighted.

The reality is that this particular patient is likely to get better care privately than he would through the NHS. His disease is poorly controlled, largely due to a lack of motivation on his part, and a patient like this often gets lost in the NHS. He is someone who, after years of not taking much interest in his health, has suddenly decided he must sort himself out. He needs to be seen quickly, while his enthusiasm lasts.

And so I am back to the debate that I so often have with myself on the relative benefits of private medicine versus the NHS. My instinct has always been to reject private health care in favour of the NHS, the core values of which I respect enormously. The concept of providing health care for all irrespective of status or wealth sits better on the conscience of a doctor than demanding cash for your assistance. And yet the NHS has become all about money too. True, it's about saving money rather than making money, but is that any better for the patient?

As a GP, I have actually often thought that working within the constraints of the NHS tends to result in a better level of care. Due to the fact that resources are limited I have to think much harder about what investigations are really important and which patients I do or do not need specialist help with. I hope most would agree that this is actually better medicine than just subjecting anyone who comes your way to a barrage of tests. Where the NHS fails however is in those situations when an individual is unwell and needs investigations quickly, but is not quite ill enough to be in hospital. These patients often have to wait weeks rather than days for vital tests which increases anxiety and delays treatment.

In truth, I am the NHS' biggest fan and if I was ever seriously ill it would be the NHS that I would want to look after me. I do believe however that there is a place for private medicine for those who can afford it. Not only can it reduce the demands on the NHS, but in certain situations it can be better for the patient too. If the two can work together, all the better, and perhaps then my diabetic would feel less of a traitor.

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