Private Practice

Sometimes, it has to be said, I am disappointed and disillusioned by my Consultant colleagues. Like the time I heard a colleague approaching retirement holding forth on the sheer inadequacy of his pension. Knowing him to have paid for his house, and having no longer any dependant children, I reflected that his pension was going to be equivalent to twice the average national wage, and I remember thinking what a pompous greedy little f****r he was.

The area where I am most often disappointed is in the way some of our colleagues conduct their private practice. Don’t get me wrong, I have no objection to the principle of private practice. What a Consultant does in his own time is entirely his own business. But that is where the problem lies. Some (a minority) seem to have rather strange ideas about what constitutes their own time.

For clarification I checked my own contract, which I imagine is similar to everyone else's. It states quite clearly “You may not carry out private professional services during your programmed activities” That seems pretty unequivocal to me.

And yet relatively recently I have seen three examples of practices which blatantly flout this contactual obligation.

The first and most common is the practice of leaving a trainee to finish a clinic or a theatre session leaving the Consultant free to nip down the road to St Graspers. I fully accept that towards the end of their training senior trainees need their cord stretched a little before it is cut and that managing patients on their own is a necessary part of this process. But if a Consultant delegates such work to a trainee he should at least remain in the Hospital and making himself unavailable is thoroughly reprehensible.

The second and more brazen abuse arises when a Consultant takes sick leave from his NHS post, usually for a perfectly legitimate reason, but still seems to find the resilience to attend his patients in the private hospital.

But to my mind the worst abuse is the following scenario.

A trainee, on duty in the evening encounters a clinical situation where he feels out of his depth and phones his Consultant requesting assistance. His Consultant tells him that he can’t come as he is busy (in the private hospital as it happens) and that the trainee will simply have to manage. There is no excuse for this. On call rotas are arranged well in advance and making arrangements to do private work on your night on call is a disgusting practice. It is not fair to the trainee and is certainly not fulfilling your responsibilities to your patients, It is a blatant and deliberate breach of contract motivated by greed. In my view there is only one appropriate way to deal with this type of practice. Instant and summary dismissal.