Wednesday, 12 November 2008

Nothing New From Sir Liam Donaldson

The BBC News website has started a new weekly column that is to allow leading clinicians and experts to outline their views on health topics. The first of these columns has been provided by Sir Liam Donaldson, the Chief Medical Officer for England. As Sir Liam probably hasn't seen a patient for a great many years (and I am sure that the many medical bloggers out there will confirm this point) I am not sure that one could really refer to him as a clinician any more because that implies someone who is practising medicine on a regular basis, and to call him an expert would probably have many doctors choking on their morning coffee for was he not one of the major architects of the MMC/MTAS fiasco?

The column that he has written seems to provide little of any significance about health or the NHS. He seems to believe that one of the ways to improve the service that the NHS provides to patients can be to mirror the service provided by shops. He sees patients as 'customers' a term that I believe many patients consider to be insulting. He highlights a case of a friend of his, who on arriving early for a GP appointment, was greeted by the receptionist saying, "you're early, I hope you don't expect to be seen early". Apparently Sir Liam's friend was "embarrassed and belittled" by being spoken to in this way in front of the other people in the waiting room. While one would perhaps be a little disgruntled at being spoken to in this way, to be embarrassed and belittled is perhaps a little over the top. It is an unfortunate fact that in many GPs surgeries these days, the reception desk is in the patient waiting area. Being used to a surgery where the reception was in a room separate from the waiting room, I found it a little awkward when I started at the GP practice that I am with now to find the reception in the waiting area. After all, who among us wants a large portion of the local population to know that you have come to make an appointment for a smear. I am sure that we have all come across the receptionist who perhaps isn't as polite as should be expected, but the way to deal with it is to have a word with the practice manager, after all there may be a reason why the receptionist hasn't been the best ambassador for the practice. Sir Liam goes on to admit that the case of the impolite receptionist was not a matter of life or death, but suggests that we wouldn't be spoken to in this way by a member of staff in John Lewis. I think that he is wrong, because I have had more problems with impolite shop staff than I have ever encountered in the NHS.

Sir Liam cites the report by Lord Darzi and talks about high quality care from the NHS which should include faster treatment, more accurate diagnoses, and better survival rates from life-threatening conditions. However, one wonders how easy this will be to achieve when there is concern within the medical profession about the lack of experience that will be the result of the changes that have been made to the training, time taken  and experience required to achieve consultant status for doctors in the future. While it is only right that junior doctors should not be expected to work the ridiculous hours that was expected in the past, this should be taken into consideration when it comes to the length of time taken to reach consultant level. There is significant concern at the level of dumbing-down that seems to have occurred in our schools and the examinations that children sit, do we really want a similar dumbing down in the medical profession because mistakes have been made in the way that doctors are trained.

As I say, there isn't anything new in what Sir Liam has to say, nor should we perhaps expect it. He has spent too long away from the coal face and has no real idea of how hard many in the NHS are working to ensure the best possible service for patients that they can. The problem is that in many cases it is the multiple layers of management within the NHS that is responsible for things not working at optimum levels. Perhaps this is the area that needs to be examined more closely and compared to that within organizations such as John Lewis.

1 comment:

Anonymous said...

You are absolutely right there is nothing new in what he said. Look underneath what he said and you will find what is new - the concept that the NHS can be handled like the high street. I think we are entering a dangerous period where the credit crunch will begin to dictate how we operate other areas of our life. This can be seen in other sectors already -charity for example - they are nothing more than a business sector now and handled such. In the states reaction to 9/11 has seen the people there give up many of their civil liberties. Something similar could happen here with finance - wholesale changes to how we take care of our population driven by a profit mentality - what a shame.