Street scene
MEDICINE JOHN ROWAN WILSON
So the property developers are planning to, have a go at Harley Street. Well, I suppose- it- had to happen. One only has to enter one of the houses to realise that they constitute an outrage to all modern notions of living. Therfs are spacious corridors and high ceilings al4 nice old staircases you can walk up two abreast. There's far more air around than is strictly necessary to maintain life. It's all extremely- wasteful of space and highly uneconomical for the landlord.
Personally I shall be very sorry to see it go. In a_world which is becoming increasingly‘ uniform, so that the traveller finds it difficult to remember at times whether he is in Munictit Milan, or Manchester,' there is surely .some. thingto be.said for preserving one of the few localities that has a distinctive character of its own. Harley Street is, after all, famous throughout the world. It has a place in British literature: There is nothing comparable to it anywhere else-If you go-to see a specialist in New York- you goto an -office in a skyscraper - —you might as well -be visiting a stockbroker or an executive of the Chase-Manhattan Bank, Of course, we are not talking about just one street. The area where consultants have their private rooms extends over a whole area, including Wimpole Street, Queen Anne Street, Devonshire Place, and a number of other side turnings. However, Harley Street and Wimpole Street have the smartest sound to them. This has led to considerable confusion, since the landlords have given way to the _temptation to carry house- numbers around-the corner, so that an appreciable number of Harley Street addresses are not,- by any ordinary standards, in Harley Street at all. Presumably the postmen have got used to it by this time, but it is
confusing to the casual visitor. •
The occupants of the consulting rooms are mostly consultants from the big London hos- pitals. A consultant will spend a varying' number of mornings or afternoons a week at his rooms, according to the size of his private practice. If he wants to admit patients for in- vestigation or surgery, he asks them whether they want to be treated under the Health Ser- vice or privately. If they opt for the Health Service, he puts them down on the waiting list at his hospital. If they want private treatment, he gets them into the private wing of the hos- pital or one of the London nursing homes. In my experience he never puts pressure on them to have private treatment. There are few things doctors like less than treating patients who are in a state of chronic anxiety about the size of the bill.
There is still a flourishing private consulting practice in London. Obviously the number of private patients varies very much with the eminence of the doctor. A knighthood or a peerage is an enormous help. Some specialties are more profitable than others. General mu-- geons, heart specialists and dermatologists do especially well; neurologists, orthopaedic stir- " geons and, contrary to popular belief, psychia- trists do relatively badly. For the real medical celebrities there are patients, not only from London, but from the rest of the British Isles and even abroad.
Starting up a private- practice in the first place is expensive, since rents are high. The young consultant rents a room for one half- day a week, with the part-time services of a secretary and receptionist, and waits hopefully. He is not, these days, desperately anxious. He has a decent income from his hospital work.
He is in contact with the GPS who send cases to his hospital outpatients, and sooner or later
one of them is likely to have a patient who would sooner be seen privately. The GP feels a certain obligation to use the same consultant who sees ,his cases at the hospital.
What does the patient get out of a private consultation? Quite a lot, really. He is likely to get an appointment sooner than in a hos- pital, he has a pleasanter place to wait in, he gets a somewhat more leisurely consulta- tion, and he has a definite guarantee that he will see the consultant of his choice and not one of his assistants. He pays for this a con- sultation fee which varies between five and twelve guineas. The size of the consultation fee is no indication of the quality of the con- sultant; indeed, one GP friend of Mine claims that precisely the opposite is the case. Age, fashion, conscience and effrontery all play a much larger- part than clinical knowledge in deciding the size of the fee. The interesting thing is that even twelve guineas is equivalent to only. three ,guineas before the war, which was considered rather- a moderate fee at the time. So it is arguable that a Harley Street consultation can take its place with wine, theatre seats and men's trousers, as one of the few things which are actually cheaper than they used to be.
To pay a few guineas for, a little personal attention seems a pretty harmless thing, even in this egalitarian world. However, there is a more serious criticism directed against Harley Street. It is alleged that a private consultation is often used' to secure a favoured position on the waiting lists of NHS hospitals. This is often hotly denied by consultants, but per- sonally I believe there is some truth in it. If a consultant has fifty patients on his list-wait- ing for a varicose vein operation, and two of -them have seen him privately, there is a distinct temptation to give them some degree of priority. It shouldn't happen, of course.. It is indefensible, just as it is indefensible for Labour ministers to prate about equality and then demand privileged treatment for them- selves on the ground of their supposed value to the -community.. One has to face the fact that this is a wicked world. And one of the nastiest aspects of it is the hypocrisy.
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