Further Confessions of a GP

Many doctors and patients are scared of thinking of health care in terms of money. The fear is that we medics will no longer see you all as real people in need of medical support, but instead as pricey leeches draining away our budgets. I would like to think I am capable of considering the financial value of what I do without it automatically having a detrimental effect on my clinical decisions.

If it were up to me, I would make up for the NHS shortfall by scrapping the recommissioning of Trident nuclear submarines – £20 billion would make our budgeting meetings considerably easier to bear. With that sort of injection of cash, the improvements we could make to patient care would be staggering. Of course, the whole point of the coalition’s new health act is to make do with less money rather than more and therefore the only places we’ll find any cash will be through reducing our own inefficiencies. Anyone who works within the NHS could list several ways in which we could work more efficiently. Traditionally, doctors have thought of these shortcomings in terms of wasted time for us, and poor service for patients, but now we will be encouraged to think of them from a more financial perspective.

My first job after qualifying was as a junior surgical doctor and I had a particularly frightening consultant. His ward rounds were terrifying and when he demanded a patient’s blood results, I was expected to know them. If I didn’t have them to hand I was on the end of a bollocking that could be heard from the other side of the hospital. My response to this was to do blood tests on all my patients every day to make sure that I had every possible result to hand. Not only were my poor patients often unnecessarily stabbed with a needle each morning, but I must have personally cost the NHS a small fortune. How much? I have no idea. To this day I don’t know the cost of a standard blood test, but I should, shouldn’t I? I’m not suggesting that doctors shouldn’t order blood tests any more, but clearly knowing the financial value alongside the clinical value of what we do is important.

One of my patients got the shock of his life recently when he discovered the actual cost of the injections he is having for his rheumatoid arthritis. He has one per week and they cost £178.75 each. That’s twice his weekly rent. He wanted to know if he should add them to his house insurance, as when he has four syringes of the stuff sitting in his fridge, they are more valuable than anything else he owns. Of course I don’t begrudge him these injections. I am extremely proud that the NHS provides them for him. They have allowed him to continue working and kept him off benefits. They make a massive difference to his quality of life, but I’m glad he knows their financial value as it means that he treats them with the respect they deserve. He understands how precious each vial is and ensures that they don’t get smashed or accidentally thrown out with the mouldy vegetables when his fridge gets a clean.

The government is planning to send us all a breakdown of exactly what our tax is spent on. Should we be sent something similar about how much we cost in terms of our health care? I don’t want anyone to be made to feel guilty about using the NHS, but how many of my patients who miss a hospital appointment realise that each failed attendance costs around £120. Or that it costs £59.48 for the asthma inhaler that keeps getting left on the bus and £244 for the ambulance needed to get to A&E after drinking to oblivion on a Saturday night. I don’t advocate anything other than a free health service at the point of delivery, but just knowing the financial value of what is provided is a good thing for patients and doctors alike, isn’t it?

Danni I

One of the most striking things about Danni was how unattractive she was. I couldn’t quite believe that men paid money to have sex with her. This can’t help but sound incredibly mean, but it really was my gut reaction when she first told me her profession. Danni was 25 years old, but so slight and slim she had the body of a 13-year-old. Her face, however, looked older than her years and was dominated by bulging dark eyes with large bags underneath and sharp protruding cheekbones. Her lips were thin and the angles of her mouth were cracked with sore-looking red lines. The medical term is angular cheilitis and I remember learning at medical school about various causes. In Danni’s case the cause was basically malnutrition. The only things that went in her mouth were Coca-Cola, cigarettes, a crack pipe and her clients’ penises.