What’s the opposite of efficiency?

Arguing against efficiency is like arguing against motherhood and apple pie. How could anyone be against efficiency in health services? And when you look at the amounts of money needed to run a health system, as politicians frequently do, of course you want to use that money efficiently. In just about every policy or statement on health systems efficiency will be mentioned as one of the principles. The drive to privatise is argued on the basis that private companies are more efficient; because we all know that in public services we are sat surrounded by money wondering what we should do with all that excess left over after buying all the health system we can, perhaps some antique furniture for the surgery, or artworks for every patient?

Am I allowed to have a problem with efficiency? At least let me give it a go. The easiest ways of measuring efficiency is to measure number of patients seen each hour, or the number of patients seen by each staff member. On these measures, any services dedicated to those who need them most — the poor, the disabled, people from outside the dominant cultures — look very inefficient. Longer consultations, more staff seeing each patient, oh dear, that doesn’t look very efficient at all. Of course everybody knows that the increased complexity warrants this. We might even hope to demonstrate better outcomes. Usually, though, they take a long time to come through, and waiting for that isn’t very efficient either. I mean, while we’re waiting, couldn’t we just work a little — you know — faster? Efficiency in the absence of unlimited funding is like gravity. You can jump, you can climb a tree, you can even fly in an aeroplane, but pretty soon you’ll come back down. In the same way, we’ll make arguments about effectiveness, about equity, and they’ll be heard for a bit. And then people look again at the budget. And look again at the number of people you’re seeing compared to the others. The need to be efficient will always pull us back to earth eventually even if we have feathers.

In arguing against the endless pursuit of efficiency, it sounds like I’m arguing for inefficiency. I’m not. I am arguing for effectiveness. But we don’t have a word that expresses the opposite of efficiency that isn’t inefficiency. As soon as efficiency comes up, the only options we have are efficient or inefficient, and none of us want to be inefficient. Perhaps we need a new word: ‘equifficient’. This expresses the illusion of efficiency sacrificed actually to do the job properly. It’s the extra bit of time in this consultation that saves another consultation for my colleague 2 days from now. It’s that slightly more tailored explanation that sends someone home happier in taking medications. I hope to use equifficiency as a word in my defence. ‘I am choosing to be equifficient’ I shall say proudly. Equifficiency will be my parachute that keeps me in the air a little longer before I land on the earth with a gentle, but effective, bump.

• © British Journal of General Practice 2014