I don’t consider Robbie Williams a modern philosopher (although I appreciate others might), but one of his lyrics does resonate with me: ‘I’m not scared of dying, I just don’t want to.’ (‘Come Undone’, 2003, from the album Escapology). I believe that personality traits are hardwired — my fatalism is mingled with 1970s hedonism, and that is who I am.
I’m not given to health anxiety and I consider the marginal benefits from screening worthless when offset against the false positives and anxiety they fuel. I ain’t having any screening, taking no statin, and will continue to enjoy a cooked breakfast. When I have my heart attack feel free to tell me ‘I told you so’.
But I’m a dying breed. For many modern doctors are haunted by health anxiety. Whether this is the effect of millennial over-parenting or the product of our medical schools’ relentless and idiotic disease-mongering, I don’t know. It certainly seems to be making many people unhappy and undermining their sense of wellbeing. We are all going to die irrespective of how we live our lives, both life and death simply deferred.
The problem is compounded because doctors have knowledge but, more importantly, have access to medical friends. So doctors constantly bypass the GP, jump the queue, and speak to their specialist hospital friends. Now, obviously, many will argue that this access is a perk of the job and why shouldn’t we use the contacts we have? Surely this is what happens in every other aspect of human society? But treating friends is fraught: we often err on the side of caution, suggesting investigations, treatments, and surgery that we might not otherwise. This is unintentional, just human nature. But reflect for a moment on how many investigations and clinics colleagues will attend. This exposes doctors to the real risk of iatrogenic harms through overdiagnosis and overtreatment.
It also raises a broader, more important issue. Because doctors abuse their position to gain preferential access, they simply do not experience the NHS as others do. Doctors have a limited insight into the frustrations of patients. Would doctors wait 3 weeks to see a GP? Would you accept having to come back for blood tests 2 weeks later? Would you accept waiting a year for a psychiatric appointment? Would you accept waiting weeks for test results?
The service is poor, the communication woeful, and the attitude is variable at best. Patients are treated as an inconvenience rather than the paying customers that they are. Doctors would simply not tolerate this service, so why should everyone else?
Doctors are not normal NHS users, so have no vested interested in reforming the NHS. And reform is what is needed, not just more money for more of the same; it just isn’t working.
It’s time to ask the audience if doctors should be allowed to phone a friend and jump the NHS queue.
Phoning a friend is harming the NHS, damages the individual doctor, and is Bad Medicine.
- © British Journal of General Practice 2018