Medicine And The Media

Taking bites from health care

BMJ 1995; 310 doi: (Published 20 May 1995) Cite this as: BMJ 1995;310:1338
  1. Douglas Carnall

    Watchdog received so many health related letters and calls that its producers decided to give health its own programme. Watchdog HealthCheck is the result. Hosted live by Judith Hann and charged with “investigating with the same style and force” as its sister programme, it combined news and radio items with three short documentary reports, each lasting about seven minutes.

    First up for hard hitting analysis was the private practice of NHS consultants. Can it be right, the programme asked, that for the payment of pounds sterling70, patients should be able to shorten their wait for the same consultant from eight months to three days? Posing as prospective patients, the reporters telephoned some 40 consultants and found that two thirds offered more than one half day a week for a private consultation. This, the programme implied, means that they are abusing the NHS. It could also mean that they have part time contracts, but Health-Check did not report on this. Chris Bulstrode, a trauma surgeon who does no private work, said that many consultants are “caught in a vortex” of money-seeking behaviour and suggested that job plans and time sheets were the answer.

    It is true that there are few checks to prevent consultants from abusing a system which does provide incentives for corrupt behaviour, but pinning the blame on consultants, most of whom work more than their contracted hours for the NHS, is a let-off for the government. The HealthCheck team is to be commended for flagging the issue, but it has failed to grasp it fully. There was, for example, no mention of the fact that Britain has many fewer specialists per capita and spends a smaller proportion of gross domestic product on health than its industrialised competitors. In Britain we keep the lid on this system by letting articulate and well off people play the NHS when it suits, with access to the safety valve of a private consultation when it doesn't. Starting with the viewpoint of the “health consumer” is fine, but the answer to the waiting list problem is more complex than consultants not turning up for their NHS sessions.

    If the programme is to convince, it must be credible to both professionals and public, and its choice of subject matter will be critical. So while a new twist to the passive smoking tale—that the American courts now favour non-smoking parents in custody battles—illuminates the established issues of children's autonomy and smokers' rights in an interesting way, another item chose an atypical patient to criticise epilepsy care in Britain. Yes, Christine, mother of two educationally delayed daughters, should have been warned of the increased risk of congenital malformation while taking valproate, and yes, it seems odd that she was having one fit a day for eight years without referral to a centre specialising in epilepsy. It also seems odd that when she stopped her anticonvulsants her fits stopped immediately and have not recurred since. If, as I suspect, Christine had pseudoseizures, it is indeed a tragedy that she took valproate for so long. However, women with epilepsy need individual advice on the risks and benefits of continuing their anticonvulsants through pregnancy; they don't need alarmist documentaries that use atypical cases to illustrate a common condition.

    HealthCheck is certainly getting to the big issues, but does it do them justice? I fear that it runs the risk of trivialising important issues and needlessly sensationalising others. This is not to question the integrity of the team that makes the programme but to question the nature of the format it has chosen. A seven minute report doesn't give long to reach the truth. Still, if a general practitioner can see a patient every eight minutes, perhaps we shouldn't complain too loudly.—DOUGLAS CARNALL, editorial registrar, BMJ

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