Looking for the Wednesday Wandering? Page back one to hear why I think titles give shape to works of art and put in your suggestion as to the title for a specific painting. Then join me and Alan on our continued journey through the convolutions of the medical system.
JANE: One of the horror stories we often hear here is that because doctors in a socialized medical system can’t get rich, they do a poor or indifferent job. Have you found that’s the case?
ALAN: No, not at all. Standards of care in both the public and private health sector, are very high. And the specialist you see in the public service will probably be exactly the same person you would have seen had you gone privately. (All doctors in private practice also work in the public sector.)
JANE: Are they required to work in the public sector or is this just the way things work out?
ALAN: I don’t think there’s any legal requirement, it’s just the way things work. And of course, by continuing to work in the public sector they are giving something back to the community. Many doctors feel that’s an important moral duty.
So you can see, Doctors who did a “poor or indifferent job” in the public sector would quickly find themselves losing their private patients as their reputation suffered. In the final instance, they might even be struck off the medical register and not be allowed to practice as a doctor again.
JANE: But nobody’s perfect. Surely things sometimes go wrong?
ALAN: Indeed they do. When I was a teenager I broke my left arm playing rugby. I was rushed straight off to hospital and they gave me a general anaesthetic and set my arm. Unfortunately, they set my right arm instead…
When I came round from the anaesthetic, I pointed out that the plaster was on the wrong arm. They were mortified, and rushed me off to X-ray in case they’d accidentally broken my arm when they heaved on it to reset the bones. Fortunately, they hadn’t and they put me under again and set the proper arm this time.
My father was furious. “What if it had been an amputation?” he yelled to all and sundry.
JANE: I know that in the U.S. many people would consider that grounds for a lawsuit. Did your family consider that option?
ALAN: No, not really. We’re not a very litigious society. Since there was no harm done, I doubt if we’d even have been allowed to sue.
How does the standard of care work in your system? Could this kind of thing happen with you?
JANE: Of course it does. As you said, doctors are only human. I also think they are incredibly overworked. When Jim had his sinus surgery, he was the last scheduled procedure for the day. A variety of delays and complications (not all medical; a computer crashed) meant Jim’s surgery was delayed for something like four hours. When the doctor came by to apologize, I asked him if he was up to doing the procedure. He assured me that he was going to sit down, drink some tea, and rest while Jim was given his final prep. Still…
On the subject of errors, I can’t provide a lot of personal stories because Jim and I have been fairly healthy thus far. I do feel that doctors vary widely in quality. I honestly am not certain if the grueling training (including abusively long hours for residents – the final stage of training) makes for the best doctors.
One thing that troubles me is that the doctor that a patient sees – especially for a non-emergency procedure – is often dictated by who is available within a given “system.” Someone in a different system, or who can pay for care without need for insurance, might get different, better care. And people without insurance must make do with what they can get – or do without.
That troubles me.
ALAN: There’s an old Tom Lehrer joke about a doctor who specialises in “diseases of the rich.” I’m not sure I’d feel very comfortable about seeing a doctor who was motivated mainly by money. Most health professionals of my acquaintance seem to have entered the profession as altruists. Though having said that, if you ascend high enough up the ladder of specialisation, rich pickings definitely await in private practice.
JANE: But if it isn’t a desire to get rich, then why do your doctors have private practices as well as public?
ALAN: Oh gosh – who can really judge another person’s motives? I don’t think anyone ever actively decides that they don’t want to make money. So when and if the opportunity presents itself (because you’ve risen high and are well-respected in your field), I suspect that most people would go for it, that’s only human nature. But I don’t believe that it’s ever a primary consideration for the choice of medicine as a career.
JANE: I’d certainly like to hope not. I’ve only known well a few people who went into medicine. Certainly, none of those seemed motivated by a desire for wealth. Sadly, however, the huge tuition bills they run up in the process often create a need for wealth if they are not to be eternally in debt.
And that brings up another question, but I’m going to save it for next time.