Doctors, one to nine

I do not claim to know much about general practice, but there occurred to me the other day in asupermarket a simple idea which could, quickly and cheaply, transform the efficiency of primary care by addressing the central issue of informed consumer choice.

The present system is wasteful because patients who have a general idea what is wrong with themand what they might need are compelled to spend time waiting for and eventually seeing a doctor whose approach and style might be quite inappropriate to what is required on that particular occasion.

A couple of examples will suffice. A lonely widow with vague headaches coinciding with the anniversary of her bereavement should not encounter anyone who is in the habit of reaching for the prescription pad before she has had time to sit down.

At the other end of the spectrum, a busy accountant with a sore throat should be able to avoid the kind of doctor who inspects the notes for previous ills and life events then inquires at leisure about stress, lifestyle risks, and psychosexual wellbeing. Such encounters, particularly when they end with a routine blood pressure check, not only waste time; they can be positively dangerous.

A simple system of standard numerical labelling, already found on the wine shelves of most supermarkets, could avoid all this trouble. In the world of supermarket wine, a one denotes the driest of the dry: the kind known colloquially in German--because of the sharp indrawing of breath and the associated visceral reflexes it provokes--as a “shirt-tail-sucker.” A two is still dry, the sort of white you might have with fish or chicken. A three goes with chicken when your aunt is coming to lunch, and so on through the middle range to the sweet and eventually the overpoweringly so: the nines purchased only by mistake, saved for Christmas dinner, and even then forgotten. I have one somewhere still.

It is obvious how much a system like that could benefit general practice. After a suitable battery of personality tests and observed encounters, each doctor would be allocated a number, to be displayed with name and qualifications on brass plate, practice notepaper, and consulting room door.

Ones would typically spend most of the working day standing beside their desks saying things like “Splendid, fix it for you in a minute. Absolutely no problem” or “Nothing wrong with you. No, no, you haven't wasted my time at all.” Twos might spend more time sitting down. Threes would probably have a chair for the patient as well. By the time we get to eights and nines consultation times will have lengthened considerably and couches might be supplied, but a clear range of options would be available and the efficiency gains of open and informed consumer choice would be obvious toall.

Of course there may be teething troubles. Practices at present consisting entirely of either ones or nines would face problems of radical redeployment. Current rigidities in appointment times will also require to be addressed. And the ones might reasonably demand equal remuneration for fewer sessions while the nines could--just as understandably--request special rights to early retirement.

I have no strong views on such details, probably best left to those with a closer interest in primary care. And since I am increasingly concerned at the exorbitant fees charged for health care management consultancy services I propose to set a good example by offering this innovation free to all who wish to use it. However, if it catches on and proves widely successful, I would not be averse to some little token of appreciation from the general practice fraternity--perhaps a Safeway's wine voucher, or even just an honorary fellowship of their college.--COLIN DOUGLAS, doctor and novelist, Edinburgh