If symptoms
persist. .
ONE OF THE hospital managers gave us a lecture last week on the forthcoming reforms of the Health Service. We've been through reforms before, of course: they're like the epidemics of Asiatic cholera that swept through Europe every ten years or so during the first half of the 19th century, terrorising the population. The problem with cholera is that it doesn't leave you immune from the next attack — just like reforms, in fact.
In the past, the reorganisations of the Health Service have in practice been less than fundamental, adding two or three layers to the bureaucracy and giving new titles to old employees. The principal effect in our hospital of one of these reorganisations, as far as I recall, was the appointment of an Auxiliary Services Manager (Laundry), after which my ward suffered a severe shortage of sheets and a huge, indeed overwhelming, sur- plus of X-ray gowns. But we were assured that the present reforms were altogether more far-reaching in scope.
I must admit that the manager did a good job of explaining what he called the 'philosophy' behind the proposals. They will involve a complete 'culture change', he said: the rigours of market competi- tion will replace the cosy monopoly in medical care that has existed heretofore. At this point, the manager soared effort- lessly upwards into the poetic realm of analogy. The relationship between those who held the purse-strings in the brave new Health Service and those who actu- ally provided the medical care would be like the relationship between Marks and Spencer and the manufacturers of their underwear.
According to the manager, the Gov- ernment had been much impressed by the efficiency of Marks and Spencer when drawing up its reforms of the Health Service, and had used the compa- ny as a model. 'What,' interjected a doc- tor in the audience, 'about our sandwiches?' Could we now look for- ward to sandwiches of a quality to match Marks and Spencer's at our clinical con- ferences? Everyone was agreed that if the reforms could do that, there might be something to be said for them after all.
The analogy between doctors and
manufacturers of underwear did not please everyone, however. It is not that we doctors have anything against such manufacturers, but we think of our pro- fession in rather more elevated terms. We are learned men, with half-moon spectacles. Besides, we don't want the public complaining about what we do in the way that, presumably, they complain about underwear. Another of the lamentable ideas behind reforms is that doctors should be accountable for what they do (though not to the public, only to accountants).
Speaking for myself, I don't want any- one breathing down my neck, examining whether my patients stay more days than necessary in hospital, fail to get better, are prescribed too many drugs, have to wait too long for an appointment etc. I want to be a free agent, to throw tantrums when I feel like it, to bury my mistakes in silence etc. If I were a Cali- fornian, I might say that I want to be me. What's the point of all those years of study and toadying to senior doctors one couldn't abide if, at the end of it all, one still has a boss?
Theodore Dalrymple
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