What is it about going to the doctor? I don’t know about you, but it always makes me nervous. Well, not so much nervous as feeling a bit like I used to feel, as a little boy, when summoned to see the headmaster (obviously before I learned from personal experience how nice heads are!)
My doctor’s charming, helpful and understanding. Nonetheless, before any appointment with her I can’t resist going through a ritual: trying to be a bit thinner; counting my units of alcohol in the past week; in effect, doing everything I can to avoid a telling-off, despite the fact that she never does tell me off.
I’m not unique. Many blokes my age have a relationship with our GP that is complex, given our limitless human capacity for self-deception. What then should we make of government’s bright idea of paying GPs £55 every time they diagnose dementia? Will that change my relationship with my GP? Will she be eager to earn a little more by spotting the early signals of my losing my marbles? My doctor, for one, is rather better than that.
What’s this about? We go to doctors expecting highly trained, well-informed and impartial advice. Impartial. Not constrained by rationed resources, shortage of money or even absence of cures: we want a diagnosis and then the best treatment available. And, notwithstanding the current travails of the NHS, in Britain we still generally get the best, particularly if our illness is serious.
Politicians suggest doctors are slow or unwilling to diagnose dementia. There may be a number of reasons for this. First, the NHS is poorly placed to cater for it. In fact, the elderly whose dementia takes them to a point where they can’t be cared for at home have to fund their own care, at an average cost of £600 a week.
That’s a huge burden, encompassing the heartbreak of selling people’s homes to fund it: but, although research continues into the causes and possible cures, dementia is not currently a major cost to government. At best, then, the plan might produce the negative consequence of identifying dementia patients without additional resources to treat them. Then there’s the fcat that a GP can’t actually diagnose dementia: that’s a specialist’s job.
The greatest nonsense of this £55 wheeze lies in politicians’ assumption that dangling money in front of GPs will make them behave in a particular way. There are perhaps grounds for arguing that, if someone is paid to manufacture 50 widgets per hour, the promise of extra money might encourage them to produce 60. Even that simple scenario constitutes dubious management theory, however, and falls down when applied to the work of a professional.
Doctors are professionals. To be a professional means you keep going until the job is done, not knocking off at a certain time or after a certain amount of money has been earned.
This plan is a gross insult to medics, the vast majority of whom are committed, thoughtful and tirelessly caring. They follow a vocation, indeed. To attempt to pressure doctors into making diagnoses of a particular type is as daft as suggesting we pay judges a bonus for finding more people guilty of rape: or traffic wardens for issuing more parking tickets. Oh, that last one’s already been tried.
We need to achieve better, swifter diagnosis of a condition that’s a growing problem: but this is not the way to do it. Doctors’ apparent reluctance to diagnose isn’t designed to annoy government: they’re cautious in identifying the condition because it’s difficult. That, too, is the professional response.
That cuts no ice with politicians who always want change immediately and who, besides, have always distrusted the professions: that’s principally because dedication, vocation and selflessness are qualities alien to most of our ruling class.
I wonder: shouldn’t we pay doctors a bonus for diagnosing such political quick fixes as, well, demented?
- Dr Bernard Trafford is Headmaster of Newcastle’s Royal Grammar School. The views here are personal