Saturday, 31 July 2010

Private Practice again

I have commented before on how a minority of Consultants can behave less than honestly when it comes to when they conduct their private practice. There is another aspect of dishonesty in private practice, that of how it is conducted. In NHS hospital practice it is easy to work in the best interests of the patient as for the most part our pay is not in any way affected by what treatments we recommend to our patients. The same is not true of private practice, where some treatments may be far more lucrative for the consultant. This is described well in “the Citadel” where some of the Harley Street set of the time (pre NHS) were described recommending treatments they knew to be ineffective and worthless, in the pursuit of financial gain. Rather like pharmacists and homeopathy today.

This is a temptation that can still today face any doctor in private practice, and is summed up beautifully by Cronin in the phrase “a struggle between all that he believed and all that he wished to have”
Sadly a minority of our colleagues lose this struggle. Occasionally a consultant’s conduct in private practice is so brazenly dishonest that they come to the attention of the GMC. This case is a good example, which should horrify any doctor with any integrity at all. I don’t think anyone could argue with the GMC decision in this case.

But there are many others who get away with it. I have two colleagues in the same speciality, who both sub-specialise in a particular area. In their NHS practice both receive referrals for a particular condition, and both treat these people in much the same way, rather conservatively, in accordance with present evidence and guidelines. 

In his private practice Doctor A treats these people exactly the same as his NHS patients, which, I expect, earns him a reasonable but modest income. Doctor B however has a totally different approach with his private patients, who receive much more aggressive and interventionist treatment. I know, from speaking to patients who have seen him, that the success rates he quotes them for the treatments he recommends are not remotely supported by evidence. Whether he is ignorant or uncaring of the truth I do not know. Dr B is well known to be unusually wealthy.

NHS or private, guess which consultant I refer my patients to.

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