I’ve noticed that the advocates of healthcare markets are very keen that patients ought to be free to choose their GP, so I’ve written an advert to help them choose:
I am a GP partner in a 5 partner, state of the art health centre in central London. I am passionate about family medicine and personal care and I see it as my duty to provide the highest quality medical care from maternal and child health to palliative home care. I work with a highly professional team of partners and associates to provide a fully comprehensive primary care service. I have excellent working relationships with the very best hospital specialists and we pride ourselves in our team work so that you have the best possible integrated care whenever necessary. I have special interests in musculo-skeletal medicine and neurology and I am an honorary lecturer and teach clinical skills to GPs and medical students.
Did I convince you?
Did you notice I said absolutely nothing about how I compare with other GPs on quality, productivity or efficiency? There’s no way of measuring these things, so I couldn’t tell you even if you asked. So if you were hoping to use market forces to drive up quality, you might run into some problems.
One thing I’ve noticed is that whenever someone is claiming that ‘people’ ought to be free, what they usually mean is that ‘they, personally’ ought to be free. They are not usually thinking about the alcoholic, drug-addicted, homeless, schizophrenic, diabetic amputee directing the traffic from their wheelchair. (He’s my patient)
Most of my ‘regular patients’ are not very choosey. They are elderly, illiterate, anxious, depressed, disabled, sick and in need of care. But they are not very good at choosing. They are not, on the whole, inclined to look online for reviews and consumer forums before buying a new iron or opening a bank account. In fact very few people change bank account even when they are dissatisfied with the one they have.
The problem with you, literate reader, choosing me, competent GP, is that because I can only provide a comprehensive service to a limited number of patients, the more of you that choose me, the less room there will be on my list for patients who really need me.
This is the Inverse Care Law.
As Marx (Groucho) might have said,
“I would refuse to register any patient who would choose me as their doctor”
I do believe that patient choice is at the core of humane, patient-centred medicine. Every consultation I have with every patient involves careful discussions about important choices. I’ve written a lot about it. You could start here: The choices patients make.