Soundings Soundings

Making time stand still

BMJ 2001; 323 doi: (Published 21 July 2001) Cite this as: BMJ 2001;323:173
  1. Liam Farrell, general practitioner
  1. Crossmaglen, County Armagh

    I was being interviewed recently on radio about primary care groups. My voice, like my life, has an irritating nasal twang, but for once I was being impressive and articulate. “You obviously have a very clear understanding of this subject,” said the interviewer admiringly. “Yes,” I said, “and that's because I'm making it up as I go along.”

    We seem to have been continuously reorganising over the past 10 years, and at this stage I have given up on keeping track of it. Though I don't particularly blame the current government for the lack of resources, it can be blamed for its lack of honesty and the pretence that the state can continue to pay for all essential health care. The state can't pay, and won't pay. There isn't enough money, so there isn't enough care. More resources will have to be provided but maybe the all-powerful “new Labour” will be able to grasp the nettle. A new health tax, maybe?

    Until then things will only get worse; increasing public expectations, increasing costs of new technology, an increasingly elderly population. The general public cannot understand how mind-bogglingly expensive free health care actually is, but I think doctors have mostly been realistic about this situation. We realise that resources can never meet the demand for health care, and that prioritising and rationing will always be a necessary evil.

    But recently things have been getting too bad to stand back and say nothing. For a start, waiting lists are a joke. I now routinely ask patients if they will consider a private referral, though I intensely dislike private medicine and its erosive effect on the trust required between doctor and patient. I used to work in a system where patients were charged for each GP visit. “Take the money off them,” said a senior colleague, “when the tears are in their eyes.” Referring a patient as non-urgent to orthopaedic outpatients is actually not a referral at all; that patient will never ever be seen. I could slip that referral letter into a spaceship bound for Alpha Centauri, and when that spaceship comes home, the patient will be no further up the waiting list. It's a way of making time stand still, somewhat akin to the time-space implications of Einstein's theory of relativity, and I shall be contacting NASA shortly.

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