Is There a Government Agent in the House?
Yesterday, Lynda and I had a meeting with the four doctors of our local practice. We were pleased to be given the meeting which was convened to discuss my recent long illness and brush with death through pneumonia/sepsis/acute kidney injury. Had it not been for Lynda’s brilliance and determined intervention during my illness, I certainly would have died. There were questions to be asked.
The doctors of our practice are typically intelligent, well-educated, sometimes affable, experienced practitioners, of good intention, but we did not get very far with them in terms of their acknowledgement of any short comings in their procedures. The embattled front liners of our squeezed and threatened NHS are ultra defensive, but hopefully some seeds were sown during our meeting that will alert them to act differently in future similar cases.
A few days previously, a friend Jessica and I had been discussing the existence of what we saw as a conceptual disconnect on the part of NHS GPs between their patients and the payment for their treatment. The patient of a private hospital receives treatment, gets out their debit or credit card and pays for it, establishing an obvious and direct connection between patient and payment. The connection between an NHS patient and the payment for their treatment is less obvious and direct. Jessica and I concluded that this prevented NHS doctors from seeing their patients as paying customers and this offered a possible explanation for the doctors’ prevailing condescending attitudes.
Proof of Jessica’s and my casual theory was about to be demonstrated in a rather startling way.
Towards the end of yesterday’s meeting I contrasted what I see as the poor interpersonal skills of the reception staff at our local practice with the superior interpersonal skills of our local bank staff and the receptionists of the private hospital where I once happened to have been seconded for a hand operation.
The doctor in charge of our practice got hot under the collar at this, ‘But, Terry,’ he said, ‘you’re not comparing like with like! When you’re at a bank or a private hospital, you’re a paying customer.’
‘I’m a paying customer when I come here,’ I protested.
Astoundingly, all four doctors laughed loudly – all four of them together, scornfully, in unison – and chorused, ‘No you’re NOT!’ It had the ring of Prime Ministers Question Time about it.
‘Of course I am,’ I insisted, shocked by their reaction. ‘Who on earth do you think pays you?’ Again, in a chorus of derision, the four yelled: ‘THE GOVERNMENT!’
How scary is that? There were Lynda and I in a meeting with four GPs who have absolutely no real idea of where their funding comes from except that, to their minds, it definitely does NOT come from the pockets of their patients.
‘Can’t you see,’ I asked, ‘that “The Government’s” money is OUR money, they get it from US? That’s how the system works. We pay National Insurance and taxes and a portion of all that money is allocated to the NHS which in turn pays your salaries. The doctor in charge almost exploded, ‘That’s ridiculous,’ he said, ‘we pay taxes too. Are you trying to say we pay our own salaries?!’
‘Well . . . yes,’ I said, ‘in part, of course you are. We’re all paying your salaries, jointly, together. We are all paying customers. When I come to see you, I come to see you as paying customer . . . sorry.’ I’ve no idea why I apologised.
It was plain to Lynda and me that the doctors remained unconvinced. One wonders what on earth their understanding of the “The Government” must be and where on earth they think it magics its budget from?
So, if you are looking for a reason behind the systemic condescension and arrogance of NHS doctors and consultants, look no further. They apparently see themselves as some kind of elite salaried agents of an autonomous self-funding entity called “THE GOVERNMENT” that has briefed them to treat the ill health of a succession of non-paying, endlessly needy, malingering nuisances, aka “patients”, aka you and me.
How bloody depressing is that?