One of the things that caused me to become increasingly disenchanted with modern general practice was the apparent shift in priorities – away from the patient’s agenda in the consultation to that of our political and professional masters. I mean, if you go to the doctor to discuss a particular concern – even fear – about your state of health, do you really want to be submitted to a tick box exercise to determine your eating habits, whether your grandmother had knock knees, or what is your sexual orientation, just so that the doctor can meet targets and not have his pay docked id he doesn’t? And do you want then to be submitted to a load of health education waffle that you never asked for and that, if you did want it, you could just as well get from a leaflet in Boots?
I always felt that doctors were there to listen to patients, and that the consultation was the patient’s arena. In the great majority of situations the patient’s worst fears are never realised, but in my experience they felt better for having been heard and taken seriously, and not made to feel foolish or that they were a time waster. Of course, the health education should be made available to them – probably just as effectively from a rack of leaflets in the waiting room – if they wish to avail of it. The same with screening for blood pressure, cervical cancer or whatever. I got in to awful trouble once over a letter I had published in The Times in which I supported an earlier objection by Germaine Greer to women being coerced into having cervical smears whether they were in a high risk group or not. The fact was that in order to meet targets and have their wallets loaded accordingly, GPs were going so far as to make thinly veiled threats that they would “strike off” women from their lists who refused the service (actually, it is not patients who are “struck off” – it is erring doctors who get their names erased from the medical register).
So far as most health education is concerned, it would seem to be a monumental waste of time and money. People who live unhealthy life styles will go on doing so for as long as they are not held responsible for the consequences. I long despaired of discouraging young people from smoking. I mean, unless they are wholly illiterate, they can surely get the message from the big bold black letters on their pack of ten cancer sticks, can’t they? And one of the very few complaints that came my way (and which went straight into the bin) was when I made a 15 year old read out to me from his pack “Smoking Kills!”. His mummy said he was really upset and demanded an apology. Needless to say, she never got it.