Category Archives: general practitioner

The near-impossibility of seeing a GP

Dalrymple, who is no doctor-botherer, says that getting to see a GP, or family doctor, in Great Britain’s sovietised health system is

difficult, intimidating and unpleasant. I have to run a gamut of procedures to do so, and face a receptionist who treats me as a fraud trying to get something to which I am not entitled. And I have no practitioner whom I can call my doctor. The NHS has crowded out private competition, and the nearest private doctor is 25 miles away.

If Dalrymple wants to see a doctor,

it is easier, quicker and more pleasant for me to go to France than to the health centre 300 yards from my house in England.

It reveals something about Britain that is not true in France:

In our dealings with the National Health Service, we are a nation of paupers who must accept what we are given by grace and favour of the system.

Getting to see a GP is a labour of Hercules

Securing a five-minute slot with a family doctor in Britain’s Soviet-style health system is extremely difficult. It is necessary, Dalrymple explains, for the patient

to lie or exaggerate. He must become expert at doing so.

If you are lucky enough to be granted an appointment, for three weeks’ time,

it is awarded as if it were a minor decoration — an OBE, say, for exceptional persistence. You have joined the privileged few. You should be proud and grateful.

The doctor as production line worker

The GP is no longer a member of a liberal profession but an executor of government diktats or obiter dicta

Ever increasing numbers of doctors: acute shortages of doctors. Such a miracle, writes Dalrymple, is one that

only our government could have wrought.

Dalrymple points out that about 250,000 doctors are registered in Britain,

but it is more difficult now to get to see any of them. There is said to be a crisis in medical manpower and that this necessitates the importation of a further 3,000 doctors this year. Fewer than two-thirds of doctors in Britain trained here. Britain parasites the rest of the world. It has outsourced a lot of undergraduate medical training.

Bureaucratic fatuity

There is a big shortage of general practitioners (i.e. family doctors or primary care providers). Young doctors do not want to go into general practice; training posts go unfilled. This is to a great extent because of the administrative burden. GPs must

spend untold hours filling forms of a soul-destroying and unnecessary kind. This is a slow kind of torture. The demands placed upon them by a bureaucracy composed of people who have little or no understanding of medical practice are immense.

Rules laid down by fools

GPs’ pay

depends on their compliance with rules laid down by fools, and this is not a happy situation for an educated and intelligent person.

Computerisation has been a factor, because for the bureaucratic mentality,

if a piece of information can be recorded, it ought to be. Before the spread of the computer, the bureaucrats’ dream of replacing all other human activity by form-filling was impossible.

Loss of prestige

The more the work

is reduced to algorithms, the less attractive it is.

The GP

is no longer a member of a liberal profession, but the executor of government diktats or, worse still, of its obiter dicta. Eventually the GP will become redundant. What is done by GPs will be done by computers or nursing assistants.

Dalrymple points to the

steep decline in the attractiveness of medicine as a vocation, profession and career.

And no one

who ever experienced an ordinary Soviet hospital will be in any doubt as to what a decline in the prestige of the profession meant to patients.

It has long been the goal of the government, he points out,

to deprofessionalise medicine and to turn its practice into a mere job. An independent profession, with its high standards and old traditions, is dangerous to the government, especially when it is as respected as the medical profession, in a way in which a mere group of shift workers will never be. Shift work dehumanises patients and deprives the work of most of its satisfaction. It is also grossly inefficient.

The independence of doctors

has eroded almost completely, and you cannot expect highly educated people who have undergone a long and strenuous training to remain contented for very long with being harried and reprimanded by people who are of lower calibre than themselves.

A vivid exemplification of the New Hospital Order is the noticeboard in the corridor of the hospital in which Dalrymple works, which

informs the public of the senior staff of the hospital. The senior consultants, all men of considerable distinction, appear on the fifth and bottom row, under four rows of bureaucrats. The impression is given that they are of very minor significance.

The shortening of training,

both graduate and postgraduate, is another straw in the wind. New hospital consultants do not have the breadth of experience that old consultants had at their appointment, and this is because doctors are increasingly regarded as technicians and nothing more.

The questions some doctors wouldn’t dream of asking

Screen Shot 2016-05-01 at 18.15.41In John Buchan’s Sick Heart River (1941), Dalrymple explains, Sir Edward Leithen has been given a year to live by the Harley Street specialist Acton Croke.

A gas attack in the First World War has awakened tuberculosis as a delayed effect, and it is galloping through his lungs.

Although occurring only a handful of years before the discovery of streptomycin,

Sir Edward’s tuberculosis is a death sentence.

Screen Shot 2016-05-01 at 18.21.02Presumably, writes Dalrymple, Sir Edward’s tuberculosis is of the open variety, yet the appropriately named Croke

never mentions the danger of spreading it to others or shows any interest in that possibility. Was it that, in those days, certain people were so socially prominent that doctors dared not suggest to them so vulgar a matter as contagiousness?

Something similar is related in Reginald Pound’s 1967 survey Harley Street, though in this case the specialist takes a more robust approach than the general practitioner:

Screen Shot 2016-05-01 at 18.13.53

 

Screen Shot 2016-05-01 at 18.26.04Screen Shot 2016-05-01 at 18.25.03Screen Shot 2016-05-05 at 08.46.57

94 Harley Street

94 Harley Street, where Sir James Purves-Stewart practised. Here a church dignitary consulted the neurologist about syphilis-related symptoms of paralysis affecting his palate. (94 Harley Street was once the home of Meredith Townsend, successively editor of the Friend of India, the Calcutta Times and the Spectator, and author notably of the 1901 work Asia and Europe.)

The humane, reassuring family doctor

Screen Shot 2015-05-13 at 22.21.08Dalrymple draws attention to a passage in James Hilton’s 1934 novel Goodbye, Mr. Chips. Mr Chipping’s doctor, Merivale,

visits him every fortnight or so and drinks a glass of sherry with him. Dr Merivale is the epitome of the reassuring family doctor:

My dear fellow, you’re fitter than I am. You’re past the age when people get these horrible diseases; you’re one of the few lucky ones who’re going to die a really natural death. That is, of course, if you die at all. You’re such a remarkable old boy that one never knows.

Screen Shot 2015-05-13 at 22.47.42But when Mr Chipping has a cold or it is very windy, Dr Merivale sometimes takes Mrs Wickett (Mr Chipping’s landlady) aside in the lobby and whispers:

Look after him, you know. His chest… it puts a strain on his heart. Nothing really wrong with him — only anno domini, but that’s the most fatal complaint of all, in the end.

Screen Shot 2015-05-14 at 07.25.24

 

The GP is no longer a member of a liberal profession

Sir Luke Fildes, The Doctor, 1891. Tate Gallery

Sir Luke Fildes, The Doctor, 1891. Tate Gallery

He is the executor of government diktats or obiter dicta

Ever increasing numbers of doctors: acute shortages of doctors. Such a miracle, writes Dalrymple, is one that

only our government could have wrought.

Dalrymple points out that about 250,000 doctors are registered in Britain,

but it is more difficult now to get to see any of them. There is said to be a crisis in medical manpower and that this necessitates the importation of a further 3,000 doctors this year. Fewer than two-thirds of doctors in Britain trained here. Britain parasites the rest of the world. It has outsourced a lot of undergraduate medical training.

Bureaucratic fatuity

There is a big shortage of general practitioners (i.e. family doctors or primary care providers). Young doctors do not want to go into general practice; training posts go unfilled. This is to a great extent because of the administrative burden. GPs must

spend untold hours filling forms of a soul-destroying and unnecessary kind. This is a slow kind of torture. The demands placed upon them by a bureaucracy composed of people who have little or no understanding of medical practice are immense.

Rules laid down by fools

GPs’ pay

depends on their compliance with rules laid down by fools, and this is not a happy situation for an educated and intelligent person.

Computerisation has been a factor, because for the bureaucratic mentality,

if a piece of information can be recorded, it ought to be. Before the spread of the computer, the bureaucrats’ dream of replacing all other human activity by form-filling was impossible.

Loss of prestige

The more the work

is reduced to algorithms, the less attractive it is.

The GP

is no longer a member of a liberal profession, but the executor of government diktats or, worse still, of its obiter dicta. Eventually the GP will become redundant. What is done by GPs will be done by computers or nursing assistants.