Re: Unnecessary care: are doctors in denial and is profit driven healthcare to blame?
A colleague works for one of the many privately run Out-Of-Hours GP services. I
was shocked to hear that he recently received a phone call from the company to say that his
antibiotic prescribing rate was low compared with the other GPs’. Rather than praising his
practice, they asked him to increase his antibiotic prescribing in order to
meet patient expectations.
In my first six months of general practice I learnt how to reassure patients with minor illness,
explain how to self-care and encourage them to seek advice appropriately. It became clear
just how much time GPs spend promoting healthy lifestyles, aiming to improve quality of life
and prevent disease. Within a private service, I can see little incentive for health promotion.
Payment and profits depend on patient demand for the service, so why work to reduce
demand?
To me, this was a frightening example of pressure to change clinical practice, not with the
patient’s interest in mind, but to suit a business agenda. This leads me to wonder what other
pressures we will face as we start to interact more with private providers under the new
Health and Social Care Act. Are we going to be increasingly encouraged to shift our
focus away from health promotion? Will we see a decline in the conservative management of
minor illness, and a rise in the US style approach; one that is more invasive, treatment
intensive, and drug orientated?
As a GP trainee, I am acutely aware of the need to develop my skills in critical appraisal. I
believe that now, more than ever, we will need these skills to protect our
patients’ best interests. We must recognise conflicts of interest, and question the motives of
those who are not bound by our ethical code of conduct. Of course, GPs have been facing a
similar challenge for years from pharmaceutical company representatives. But I suspect
that influences on our decision-making will start coming from a wider variety of
sources, and may not be as obvious as a drug rep with a sales pitch.
Editorial note: Dr Oxley's colleague has confirmed her account of events
Competing interests:
No competing interests
23 October 2012
Beth Oxley
General Practice Specialty Trainee, Bradford Vocational Training Scheme.
Care of the Elderly, Bradford Royal Infirmary,
Care of the Elderly, Bradford Royal Infirmary, Duckworth Lane, Bradford, West Yorkshire, BD9 6RJ
Rapid Response:
Re: Unnecessary care: are doctors in denial and is profit driven healthcare to blame?
A colleague works for one of the many privately run Out-Of-Hours GP services. I
was shocked to hear that he recently received a phone call from the company to say that his
antibiotic prescribing rate was low compared with the other GPs’. Rather than praising his
practice, they asked him to increase his antibiotic prescribing in order to
meet patient expectations.
In my first six months of general practice I learnt how to reassure patients with minor illness,
explain how to self-care and encourage them to seek advice appropriately. It became clear
just how much time GPs spend promoting healthy lifestyles, aiming to improve quality of life
and prevent disease. Within a private service, I can see little incentive for health promotion.
Payment and profits depend on patient demand for the service, so why work to reduce
demand?
To me, this was a frightening example of pressure to change clinical practice, not with the
patient’s interest in mind, but to suit a business agenda. This leads me to wonder what other
pressures we will face as we start to interact more with private providers under the new
Health and Social Care Act. Are we going to be increasingly encouraged to shift our
focus away from health promotion? Will we see a decline in the conservative management of
minor illness, and a rise in the US style approach; one that is more invasive, treatment
intensive, and drug orientated?
As a GP trainee, I am acutely aware of the need to develop my skills in critical appraisal. I
believe that now, more than ever, we will need these skills to protect our
patients’ best interests. We must recognise conflicts of interest, and question the motives of
those who are not bound by our ethical code of conduct. Of course, GPs have been facing a
similar challenge for years from pharmaceutical company representatives. But I suspect
that influences on our decision-making will start coming from a wider variety of
sources, and may not be as obvious as a drug rep with a sales pitch.
Editorial note: Dr Oxley's colleague has confirmed her account of events
Competing interests: No competing interests