Friday, 23 January 2009


Quite an interesting article from Auntie today regarding the “relationship between surgeons and their patients.”

John Black, President, Royal College of Surgeons, seems to think that NHS Choices, the ability of patients to choose where they have operations, has damaged doctor-patient relationship and argues that a single consultant should once again oversee a patient's care.

He went on to say “Until recently, your GP would refer you to a single consultant who would then see you through the whole process of your care, from initial consultation to final discharge.” And “However, this cord between GPs and surgeons has been cut by the computerised "choose & book" system, which purports to offer greater patient choice but which has had the opposite effect.”

Or in other words, consultants are upset because they are not getting the number of referrals (and therefore money for the trust) from GPs because the public in it’s wisdom now has the chance to choose who they want to operate on them.

Mr Black then goes on to patronise the patients “How many patients know enough about the health service to make a really informed choice?”

He adds; “Because of the target culture, continuity of care has been severely compromised.

You might be seen initially by Consultant A, come back for your results to see Consultant B, go on to a common waiting list and then have your actual operation done by Consultant C, whom you might meet for the first time on the morning of your operation.

You may well be sent home the following day by Consultant D and if you are fortunate enough to have a follow up consultation, you may be seen by consultant E.”

And “This provides numerous opportunities for mistakes to be made, and it is deeply unsettling for the patient to be handed over time and again at every stage to a new doctor.”

But isn’t he forgetting the continuity of care protocol in hospitals, or the fact that a consultant surgeon is responsible for the care given to a patient from admission to discharge? A patient doesn’t give a rat’s arse who his consultant is; a patient wants the best treatment available, in a clean and safe environment, to be treated with dignity, and to leave hospital healthier than when he/she went in.

Patients don’t care about the old boys club where a GP will refer to a consultant surgeon because he has dinner with him/her twice a week, and plays golf every Friday at the same club.

Surgeons are happy to have the target culture when it produces income for the hospital because they can then tell all their “friends” how much they have contributed to the trust.

Another quote from Mr Black “Surgeons losing control of their waiting lists has also taken away the flexibility to make appropriate professional judgements about which patients are in greatest need and should be dealt with sooner.”

Is he saying that surgeons “bump” people up the waiting list?

How many times has a patient attended an out patient appointment and been seen by a junior doctor? I know this is a norm because I have seen it, and yes, I know they are busy people, but aren’t we all, how many patients have only seen junior doctors in the period from referral to admission and don’t meet the consultant until the day of their operation?

And then is operated on by a junior doctor under supervision? And again yes I know that they have to learn.

The point is that consultant surgeons have little contact with their patients on a day-to-day basis, and have little comprehension of the patients needs

The point is that consultant surgeons are pissed off because they have lost control of their kingdom and now have to accept the fact that the patient is in charge of who operates on them and where the operation is carried out.

Tough shit, patients are the most important people in the NHS, not GPs. not Consultants, not, Managers but patients.

Live with it.

“Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.”

- Voltaire [Francois-Marie Arouet]



James Higham said...

Tough shit, patients are the most important people in the NHS, not GPs. not Consultants, not, Managers but patients.

Yes but do the GPs acknowledge that?

Anonymous said...

I'm not sure if GPs, Consultants or Managers do James.