Thursday, 27 October 2016
If it quacks?
Monday used to be National Sicknote Day, the day when your local GP would glance at the full surgery waiting room but know he would be out on house calls by mid-morning. The genuinely ill didn’t bother dragging themselves to the local practice because it would be standing room only until the cursory examinations were completed by the dispensation of a couple of aspirin and an illegible signature securing a few days off for the malingerers. By the early eighties, Self-certification for Statutory Sick Pay allowed the workshy to diagnose their own twenty-four hour stomach bugs and freed up the doc from providing social security to get back to medicine.
In other countries healthcare is less heavily abused, probably because costs are born by the sick or their insurers at the point of treatment. But in Britain, integral as it is to the welfare state, the NHS is yet another much-abused entitlement whose heaviest users are often its lowest contributors. If you build it they will come and at times a city-based A&E department can resemble the temporary, volunteer-manned mission hospital set up hastily in the aftermath of war and famine in a primitive, flyblown forgotten African state.
Whose job is healthcare really, though? Surely the care of you and yours ought to be very much yours and theirs. And while screening for less visible conditions and early treatment for some is undoubtedly vital, when you delegate all responsibility for your wellbeing to people whose time is necessarily rationed, is it any wonder that the system is regularly described as ‘creaking at the seams’, ‘in crisis’ or that we have a matter of days to ‘save’ the NHS.
The Academy of Medical Royal Colleges has recently identified a number of routine treatments and checks which may have little efficacy and has called for a change of culture in how doctors prescribe treatments. Just because your patients demand treatment it doesn’t mean they need it. The press doesn’t help here, nor does the chattering of the Internet. No sooner does a treatment become available than some people are in the queue for it whether it is genuinely applicable to them or not. If blood-letting were to be reintroduced it wouldn’t surprise me to see leech surgeries springing up in Portakabins hastily set up in hospital car parks.
The NHS was once described as ‘the envy of the world’, although doubts have always existed over whether that was ever actually true. But it has always struggled against the weight of demands for it to dispense quackery for free alongside genuinely life-saving treatment. It could be argued that the gullible demand for crackpot cures and old wives’ social psychology could be provided ‘in the community’ by private providers. To relieve the pressures on general practitioners maybe we should issue vouchers to be redeemed at the local witch doctor ?
You'll just feel a little prick...
But don’t we already do that by promoting the alternative therapy scene? Reiki, acupressure, naturopathy, aromatherapy, balneotherapy, homeopathy, biofeedback, reflexology... candles, crystals, stones and bones, consulting crones; when will we three meet again? And people willingly turn to these means when conventional medicine hasn’t helped; often because ailments are imaginary, or self-inflicted. Since the NHS was set up it has gradually dropped its universal offerings; eyes and teeth and ears have all gone to private providers; why not do the same for malingering too? Outsource imaginary ailments to the imaginary cures industry and let the sickbay rangers get the treatment they deserve.