CORRUPT BRITISH MEDICINE

By Theodore Dalrymple

The distortion of medical practice by managerialism is well established. A consultant at the Radcliffe Infirmary in Oxford told me recently that, in order to meet government targets with regard to the speed at which patients were examined medically and moved into hospital beds in the casualty department, ambulances bringing patients were not allowed to transport them through the hospital doors until such time as they could be seen within the specified period. As a result, of course, ambulances piled up outside the hospital, which was tough luck on those who needed an ambulance quickly; but they were only patients, and it’s the targets that count.

Patients are being discharged from hospital not because they are fit to be discharged, and not because they beg to be allowed home, but because targets cannot be met if they are not so discharged. Kindness and decency are no longer permissible reasons for keeping someone in hospital; we must get them out, as the Americans say, ‘quicker but sicker’. So what if they come back soon afterwards with the complications consequent upon too hasty a discharge? The original illness and the complication can be treated statistically as two episodes, thus increasing the efficiency (on paper, always on paper) of the hospital.

Sometimes, patients don’t get as far as being discharged too early because they are not even admitted in the first place, when they quite clearly should be. I have seen patients who have been misdiagnosed with trivial or less serious complaints when they have serious and even life-threatening ones, not because the doctors are incompetent and don’t know what they are doing, but because they are constantly working in conditions in which each new admission to hospital creates a crisis throughout the entire system. If a patient needs admission, the doctor feels terrible tension if no bed is available. Better, then, for his peace of mind, to change the diagnosis to a condition that does not require admission (and diagnosis is seldom so certain that it cannot be doubted) and send the patient home. For obvious reasons of human psychology, this is particularly hazardous for the less attractive members of our society: drug addicts, for example. But since when are doctors supposed to consider the attractiveness of their patients in deciding whether to treat or not?

The corruption has gone furthest in psychiatry, the easiest field of medicine to corrupt, of course. So short are beds in psychiatric hospitals that patients are rediagnosed in order that admission should no longer be indicated. Psychiatric patients, according to the traditional summary of psychiatry learnt by all doctors, are mad, sad or bad: increasingly, the mad are assimilated to the bad so that they are deemed to need no treatment, since there is none for them. The nightmare of trying to find a bed in a hospital — there are none in areas with a population of five million — is thus averted.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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