Effect of socioeconomic deprivation on waiting time for cardiac surgery: retrospective cohort studyCommentary: Three decades of the inverse care law

BMJ 2000; 320 doi: (Published 01 January 2000) Cite this as: BMJ 2000;320:15

Effect socio-economic deprivation on rationing

Following the article that shows socio-economic deprivation worsens
surgical investigation and treatment of coronary heart disease. It's
January 9th and no-one has responded to this article with a sense of
outrage. After 8 days, where are the cries of foul! Is it because we
have heard it all before and can't bear the agony? Or is it because we
are from middle class backgrounds and don't really care?

I am sure a large part of the problem is doctors under pressure to
ration. The problem is particularly bad in cardiology, despite the poor
prognosis of coronary heart disease compared to say breast cancer(1).
Ideally, a person who has chest pain on Monday, should have an angiogram
on Tuesday, and a CABG on Wednesday - and this should apply routinely to
everyone. As with many other cases of rationing, I believe doctors have a
duty on behalf of society to push budgets and harass politicians to
provide for such services. We can start by being more outspoken when
articles such as this are published.

1. Bunker JP, Houghton J, Baum M. Putting the risk of breast cancer
in perspective. BMJ 1998; 317: 1307-1309

Competing interests: No competing interests

10 January 2000
Nicholas Bulmer
GP Registrar
Sleaford Medical Group