I’ve a lot of respect for a London GP, Iona Heath, who frequently writes in the BMJ, . Last week she wrote an opinion piece about what she sees as the corrupting influence of money on healthcare. I know that healthcare is a big debate in the US, what with Rudy Giuliani throwing around mis-information about cancer treatment to bash what he calls “socialised medicine”. Well, I guess if he reads Iona Heath’s views he’ll confirm his current view that the UK has it all wrong. The system of payment for GPs in the UK has changed with the government paying them for carrying out certain procedures (actually mainly paying them for recording certain pieces of information, like whether or not a patient smokes, BP readings and so on). This has resulted in massive income rises for GPs and the advocates of the system say this shows that money motivates doctors to work according to best practice. Here’s what Dr Heath says –
But if money is thought to be the only motivation, hugely important human aspirations are systematically marginalised and our conception of what it is to be human and a member of society is diminished.
And, this –
In The Burial at Thebes, his translation of the story of Sophocles’ Antigone, Seamus Heaney gives King Creon these words: “Money has a long and sinister reach. It slips into the system, changes hands and starts to eat away at the foundations of everything we stand for. Money brings down leaders, warps minds, and generally corrupts people and institutions.” It seems an extraordinarily accurate description of the state of the NHS. Money is everywhere the driver of change but it is warping minds and corrupting both individuals and institutions. There seems no place left for the altruism of public service to flourish and this is taking a huge toll of the morale of those working in the frontline of health care, whose motivation has always gone beyond the simple question of money. The neglect of altruism seems likely to prove both destructive of social solidarity and ultimately extremely costly for individual citizens.
Let me put my cards on the table. I completely agree.
From the age of three I wanted to be a doctor. Don’t know where that idea came from because there were no family connections with doctors but I pursued that dream and became a doctor back in 1978. Graduation Day was one of the most thrilling days of my life. But it’s only after graduation that doctoring starts and my training jobs were tough, demanding and challenging. In 1982 I became a GP. From the start I’ve always loved working with patients and I always brought my constant curiosity and desire to improve and change things with me. I always made what others would consider stupid decisions about money, not least deciding to leave one practice and join another in 1986 resulting in a drop in income of 70% overnight. Money didn’t motivate my medical decisions. But the government always thinks otherwise and the trend to motivate doctors to carry out government-determined tasks by paying more for what the authorities wanted the doctors to do started to take off in the early 1990s. It drove me out of general practice. It just didn’t sit right with me that I might get paid more if I persuaded a patient to choose one particular course of action over another. I wanted to help every single patient to choose the action they preferred, not to choose the one that paid me more. And I realised that when patients became aware of the payment system they started to question whether I was recommending a treatment because it was good for them or good for me. That was it. I couldn’t do that.
So I stopped.
In fact that was my crisis point. I resigned as a GP and didn’t have another job to go to. For the next 8 months, I got by on one day of clinics at Glasgow Homeopathic Hospital, a weekly radio show (Phone Dr Bob!) and I wrote a textbook of homeopathy for GPs. Financially, it wasn’t clever! Then I got the job I still do – a full-time job at Glasgow Homeopathic Hospital with half the week seeing patients and half the week focussing on teaching. It’s a great job. I love every day of it. There is no greater thrill and sense of reward than I get from the privilege of meeting new patients, getting to know people over time and helping them to find relief from suffering and to experience better health. Financially, I’d be way, way, better off if I’d stayed as a GP (or if went back into general practice now) but in terms of satisfaction and fulfilling a life’s purpose? Well, this current job ticks those boxes for me.
That’s my personal story, but I don’t think my motivations are unusual. I don’t think most doctors become doctors for the money and I totally agree with Iona Heath that creating the health care system around money as a motivator is destroying the environment in which altruism and the desire to care can thrive.
Heroes Not Zombies 