Where have all the caring doctors gone?
When our younger daughter was suffering from leukemia, our caring GP visited her at home. I was a young veterinary assistant at the time and I needed our one car for work. My wife had no other means of transport so it was natural, in those days, for the doctor to visit the patient at homeif they could not get to the surgery.
Her partners in the practice would also visit their patients in the hospital as backup care to the hospital staff. They worked a 5½ day week and shared the out-of-hours work between themselves. They would take you to the local hospital in their own cars if necessary. Consultations were not limited to ten minutes and you could mention more than one condition.
Proper diagnosis takes time
We moved to another part of the country to continue my career and found another caring medical practice. The senior partner and his family would take Christmas dinner with the residents of the local Cheshire home, where it was a tradition that he carved the turkey.
Those doctors had a vocation to their profession.
You will have guessed by now that this was before GP practices relied on computers. The doctor looked you in the eye instead of the computer screen. They tapped. palpated, and spent time listening to their stethoscopes, and examined you on the bed if necessary. You were given their time and their understanding.
Then came 1966.
The Prime Minister, Harold Wilson, had announced the government was to increase doctors’ and dentists’ salaries by up to 30%, following recommendations made by a pay review body.
Threats from thousands of family doctors to leave the Health Service for private practice prompted the Cabinet decision.
They may have stayed with the NHS but only to become available for patients on three or four days a week — and rely upon external doctors who do not know you to cover night and weekend calls.
The bonus system of 2004
We know the inevitable acronym of this scheme as QOF, or Quality and Outcomes Framework. GPs are now paid bonuses–worth up to a third of their pay — for hitting various performance targets. These include diagnosing type 2 diabetes, high blood pressure, altered liver and kidney functions, and heart disease. The bonus system means that the more clinical conditions you suffer, the more valuable you are to your doctor.
Recent research suggests that these bonuses have little real impact on the outcome of these conditions. As expected, the British Medical Association disputes these findings because it is too early to judge the merits of the system.
What is the state of the profession today?
Around 90% of people employed by NHS trusts and clinical commissioning groups are working in non-medical roles. (UK Government report on the NHS workforce in 2021)
Generating such initiatives as the QOF and their acronyms is the work of many of this 90% non-medical staff of the NHS.
When I felt capable of setting up my veterinary practice, I worked 24/7 for two years, except for Wednesday afternoon and evenings, when I employed a locum.
The practice grew to employ 5 vets and 6 nurses. with all of us sharing an equal rota of duties. This rota gave everyone one full weekend on duty; a second weekend on support duty; we enjoyed a short weekend off duty from Saturday midday until Monday morning on the third weekend. Our families lived for the fourth weekend, which started at lunchtime on Fridays and lasted until 8.00 am on the following Monday.
These weekends were like gold dust. We treasured them.
The average salary for a doctor today is £76,300 gross per year (£4,400 net per month), which is £46,700 (+158%) higher than the UK’s national average salary. A doctor can expect an average starting salary of £40,050. The highest salaries can exceed £200,000 and these figures do not include the bonuses mentioned above.
The box-tickers can not quantify kindness, care, compassion and consideration but they were the reasons for the choice of a career in medicine in the first place. It requires enormous strength of character to keep these values when almost everything in the medical profession has been monetized.
The GP of fifty years ago in his three-piece tweed suit and the front room of his house knew his patients from birth to death — and cared. The battle-axe matron of that era may have been a termagant on the surface but, in her heart, she, too, cared–and MRSA would not have dared to step foot in her wards.
Don’t get me wrong. Modern robotic medicine can perform surgical miracles, and highly expensive medications can ease symptoms that were impossible to treat previously. Unfortunately, these advances come at the cost of personal care by a trusted doctor and the enormous range of side effects of modern pharmaceuticals which require additional medication to control.
We have thrown the babies out with the bathwater — and I find it sad.