True story, as told to me by a patient this week of what happens when healthcare is treated as a commodity and patients are treated as consumers.
Caller: “Good morning Mr Smith, how are you today?”
P: “I’m alright, who are you?”
C: “My name’s Jenny and I’m calling to tell you about a new treatment for your arthritis”
P: “How do you know about my arthritis?”
C: “Over 20% of people over the age of 60 suffer from arthritis Mr Smith, and I’m calling to tell you about our new Rosehip capsules”
P: “How did you get my number, who are you?”
C: “I’m calling from the arthritis clinic”
P: “I don’t go to any arthritis clinic, I see my GP”
C: “Patients who have taken our Rosehip capsules have felt so much better that many of them have been able to stop taking their painkillers, wouldn’t you like that?”
P: “Well, yes of course”
C: “We can supply you with 3 months supply and you get the first month free for only £15.99”
P: “I get my prescriptions for free, couldn’t I just get them from my GP?”
C: “Unfortunately these aren’t available from your GP, but we can set up a regular order and send them to you every 3 months. How would you like to pay?”
P: “I don’t want to pay, I don’t even know who you are”
C: “My name is Jenny, and I’m calling from the arthritis clinic. It’s easy to set up payment Mr Smith, I can help you with that right away and send the Rosehip to you by the end of the week”
P: “I’m sorry, but I don’t know anything about any arthritis clinic”
C: “One of our customers hadn’t been able to walk up her stairs for over 6 months and was taking nearly 20 prescribed painkilling tablets a day, but now she has stopped all her prescribed drugs and is walking up and down her stairs every day. They can change your life”
P: “Well that does sound good, but I’m not sure”
C: “Why don’t you give it a go, it’s only £15.99 for 3 months supply, how would you like to pay?”
I’ve written the conversation as Mr Smith reported it to me. He said that he felt really pressured and had to hang up in the end. I don’t think my retelling makes that clear. If a company cold-called a thousand people over the age of 60, they could guarantee that about 20% were suffering from some form of arthritis, that they were taking pain-killers and were probably fed up with taking them.
If one patient says they felt pressured, no doubt many do, and enough are accepting the offer for the company to continue cold calling. The assumption we are making with the NHS bill is that healthcare is a commodity to be traded and patients are savvy, sceptical consumers.
Contrast the relationship between the caller and the patient with that of my patient and myself. Even though I haven’t known him long, I have taken time to examine his joints, read his medical records, inject his arthritic shoulder, discuss the impact of his arthritis on his mood and his ability to care for his wife. Together we have discussed his attitude to doctors and medicines, exercise and diet, his levels of independence and support, his family, his hopes and fears. Because of this we trust eachother, I trust that he will share his concerns, and he trusts that I will act in his best interests. It is a relationship un-tainted by commerce, one in which a discussion is more valuable than a transaction, shared understanding more important than a prescription or a referral.
This precious relationship has been under increasing threat for years as the NHS has become increasingly commercialised. The Healthbill commercialises the NHS more than ever before and this will pollute every intimate consultation between doctors and their patients. When this trust is lost, we will have lost our integrity and humanity.
“Medical professionalism cannot survive in the current commercialized health care market. The continued privatization of health care and the continued prevalence and intrusion of market forces in the practice of medicine will not only bankrupt the health care system, but also will inevitably undermine the ethical foundations of medical practice and dissolve the moral precepts that have historically defined the medical profession.” Dr Arnold Relman, Professor Emeritus of Medicine and Social Medicine at Harvard Medical School ccjm 2008