Skip to main content

Private practice hurts the NHS says leading cardiologist.

Private practice directly affects the quality of care that NHS patients receive and doctors should not be allowed to work on both sides of the divide, writes a senior doctor in The BMJ this week.

Recently I sat waiting for a urology test. The clinic was already running late.  When I arrived it was running 45 minutes late, but now the 'estimate' had been changed on the white board to 90 minutes.  I sat patiently waiting. It was not unusual. I had come prepared with a newspaper to read.  A woman opposite broke the 'silence'.

"I went private last time!" she declared.

Some of us looked up, wondering whether this was the solution to waiting.

"It was the same doctor!" She declared, and we wondered how a busy consultant could work both for the NHS and have a private clinic.  To whom did he owe his loyalty?

It has been an accepted part of the NHS since its foundation.  At the heart of the NHS has always been this conundrum. Does it matter? Is there a conflict of interest?  At least some doctors think so and are prepared to say so.

John Dean, a consultant cardiologist at Royal Devon and Exeter NHS Foundation Trust Hospital, describes how he quit private practice after realising it has direct adverse effects on the NHS.

To begin with, he says he felt that he needed the money to renovate the house, educate the children, and so on. And he was sure that he could keep the private work separate from the NHS work. But, he says, it became increasingly difficult to keep the lid on the private jar as the contents expanded, and spillage was inevitable.

The fact is that the business of medicine and the practice of medicine are at odds, he argues. Private medicine encourages doctors to make decisions based on profit rather than on need.

No matter how high I set my own moral and ethical standards, I could not escape the fact that I was involved in a business for which the conduct of some involved was so venal it bordered on the criminal - the greedy preying on the needy, he says.

He believes that private work has direct adverse effects on the NHS. A consultant cannot be in two places at once, he writes, and time spent in the private sector deprives the NHS of this valuable resource.

And he points out that, although patients think they are paying for higher quality medicine, the main advantage is simply to jump the NHS queue. “Private hospitals are five star hotels but for the most part no place to be if you are really sick.

But the most pernicious aspect of private medical work, he says, is the indirect effect it has on a consultant's NHS practice. It is difficult to justify subjecting private patients to unnecessary tests and treatments if you avoid doing them to NHS patients. So you have to operate the same system in both wings of your practice to ease the stress of this cognitive dissonance.

Private practice also creates a perverse incentive to increase your NHS waiting times, he adds.

The inescapable fact is that money is at the root of it all, he says, which is why he left private practice and why he believes the rulers of healthcare should draw an uncrossable line between private and public medicine and tell doctors to choose: you cannot work on both sides of the divide.

Comments

Popular posts from this blog

Maternal depression can impact child mental and physical health

Maternal depression has been repeatedly linked with negative childhood outcomes, including increased psychopathology.  Now, a new study shows that depression in mothers may impact on their children's stress levels,  as well as their physical and mental well-being throughout life.

In the study, published in the journal  Depression & Anxiety,  the researchers followed 125 children from birth to 10 years.

At 10 years old, the mothers’ and children’s cortisol (CT) and secretory immunoglobulin (s-IgA)—markers of stress and the immune system (see below)—were measured, and mother-child interaction were observed.
Psychiatric assessment  The mothers and children also had psychiatric diagnoses, and the children's externalising and internalising symptoms were reported.



Internalising disorders include depression, withdrawal, anxiety, and loneliness. They are often how we 'feel inside', such as  anger, pain, fear or hurt, but may not show it.  In contrast, externalising symptom…

Palm Oil production killing the planet

Bad trade and bad products are killing our planet. We have said this before on The Thin End. There is no better example than that of palm oil. It is used ubiquitously in so many products, and its production is a major factor destroying rainforests and threatening precious species.

Demand for palm oil is 'skyrocketing worldwide'. It is used in packaging and in so much of our snack foods, cookies, crackers, chocolate products, instant noodles, cereals, and doughnuts, and the list goes on.
Bad for the planet So, why is this so bad for the planet?

The oil is extracted from the fruit of the oil palms native to Africa. It is now grown primarily in Indonesia and Malaysia, but is also expanding across Central and West Africa and Latin America.

Palm oil production is now one of the world's leading causes of rainforest destruction, and this is impacting adversely some of the world's most culturally and biologically diverse ecosystems. Irreplaceable wildlife species like t…

Clear blue lakes turning murky in USA

New research reveals that many lakes in the continental United States are becoming murkier, with potentially negative consequences for water quality and aquatic life. These are the findings of a study published in Limnology and Oceanography.

From blue, clear lakes to greenish brown In the 5 years between 2007 and 2012, the dominant lake type in the United States shifted from clear, blue lakes to greenish-brown, murky lakes. Blue lakes declined by 18% while murky lakes increased by 12%. 



Overall, “blue” lakes decreased by ~ 18% (46% of lakes in 2007 to 28% in 2012) while “murky” lakes increased by almost 12% (24% of lakes in 2007 to 35.4% in 2012).  So, the majority of lakes are now murky.

Regionally, murky lakes significantly increased in the Northern Appalachian, Southern Plains, and Xeric ecoregions.

In the Northern Appalachians, blue lakes decreased by 41.4%, brown lakes increased by 17.8%, and murky lakes increased by 26.8%. In the Northern Plains, green lakes significantly increas…