It's life, Jim…BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6980.677 (Published 11 March 1995) Cite this as: BMJ 1995;310:677
- Tom Snow
Harley Street has the mystique of Fortnum's or Eton; we all need food, education, and health care but only the rich can afford to buy them at expensive English establishments. Harley Street also has something slightly sleazy about it, something to do with being intimately pampered in exchange for money, a feeling that there are services available here which should not really be on offer—more like Soho than Knightsbridge. Doctors are ambivalent, affecting contempt, but slightly in awe, uncertain if they'd like to be part of it. For the rest, Harley Street's rich clients and chic practitioners invoke both revulsion and envy.
This makes a documentary about Harley Street a sure thing—we want to know who these people are, how much they pay and get paid, and what it's like inside those big London houses. Unfortunately, Modern Times's documentary had no message and little structure. In 45 minutes the camera roved around the Harley Street and Wimpole Street area allowing the characters to talk for themselves. First there's Bonnie, a brave 50 year old with breast cancer who is seen undergoing bone marrow transplantation. Her consultant, Len Price, flies to New York meanwhile to present his series of 14 patients. The camera catches an American colleague passing him what was supposed to be a bit of lighthearted camaraderie, “I didn't know the Brits were tough enough to take that much chemotherapy,” and the edit takes us back to Bonnie suffering in the clinic.
The most startling sequence was a dentist preparing teeth implants for a city financier. The technical gismos are astounding—intraoral video endoscopy to show the patient what is happening and three dimensional reconstruction of the teeth from computed tomography scans. Whatever happened to plaster casting? The film helpfully gave us the cost of all this in discreet subtitles.
The programme also featured a perfect Harley Street ear, nose, and throat specialist with snow white hair, half moon glasses, a tremendous bedside manner, and a delicious central European accent. The serenity of his private consulting rooms contrasted starkly with his NHS outpatients clinic, which looked like the hold of a slave ship. In other interviews, doctors were keen to affirm their NHS credentials and to underplay the benefits of care on “the street,” but at the BUPA New Consultants Forum the cat leapt from the bag: “It is a disaster that NHS practice does not match up to private practice,” they reproached. A general surgeon complained about the high rent and overheads (£20000 a year) but added that the NHS would have to double his salary to make it worth giving up his private practice. “It's a lot of extra work,” he whined. Pass the tissues.
The good fortune of having private health insurance was a recurring theme: “We've had our money's worth.” “Well worth it.” “Every penny,” went one exchange between man and wife. People claiming on insurance always seem to think they're getting something for nothing. They're not, of course.
Some documentaries have a point to make and use film to make it, some tell a story and take their structure from the narrative; some, like this one, just point the camera at life and hope something interesting turns up. The result here is a confusion of different styles; Jimmy's, World in Action, and home video in equal parts. The programme didn't excel as any of these but was absorbing simply because of the subject. It's life, Jim, but not as we know it.—TOM SNOW, senior registrar in radiology, Bristol Royal Infirmary