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VIEWS & REVIEWS: Des Spence Beware of expensive imitations BMJ 2008; 336: 280 [Full text]

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doctor dependence

shyla c jehangir   (4 February 2008)

I Have not Heard this Opinion for a While

Graeme Mackenzie   (7 February 2008)

In Holland too

Helen A. Silvius   (8 February 2008)

doctor dependence 4 February 2008
shyla c jehangir, associate specialist in paediatrics gateshead. Send response to journal: Re: doctor dependence	dr spence takes a simplistic view of migrants and their attitudes towards doctors.patients in developing countries pay vast sums of money to see doctors and therefore expect 'results' very quickly.it takes a long time before ingrained attitudes like this change when faced with the care the NHS offers. i have worked for long periods in india and in the UK.both types of healthcare raise many questions. on the one hand, its absolutely amazing that everyone gets free care when they need it in the NHS. i have reasons to be grateful for this every single working day.however, working in india , i also found a lot more gratitude and appreciation for what you do as a doctor. i'm not saying they get better care because they pay for it.when i worked on a community project in south india, i found the free vitamins and iron we dispensed frequently thrown into the ditch outside the clinic- the attidue being that if its free, it must be 'worthless'! cultural differences towards health care are very complex. i guess we in the UK will need more educating with the influx of migrants from all over the world.there are 'diamonds' everywhere if you care to dig deeper. Competing interests: None declared
I Have not Heard this Opinion for a While 7 February 2008
Graeme Mackenzie, OUT OF HOURS GP North Cumbria Send response to journal: Re: I Have not Heard this Opinion for a While	And had forgotten how much I agree with it. In the endless debate of lack of resources and the "crap" NHS, I often scream, "but you all need far less health care, not more!!!" Competing interests: None declared
In Holland too 8 February 2008
Helen A. Silvius, GP Leiden, Holland Send response to journal: Re: In Holland too	In Holland we have a similar healthcare system, where GP's are the gatekeeper for specialist care. So a GP decides whether a patient has to be referred. This story describes pretty much my experiences. What I also experience is that some of my patients don't come back if things haven't got better, even if I ask them to do so. What they do instead is frequently visit the Accident and Emergency ward because it is freely accessible. Usually with no result since their complaints are seldom emergencies (but nevertheless sometimes serious medical problems). In this way they make a good follow up impossible. I am currently looking for solutions to improve this situation. Any suggestions? Competing interests: None declared