Tuesday, 6 October 2020

Private practice

Very early in DZ’ career he watched a debate on regional TV about the place of private practice in UK healthcare. On the one side was an eminent and respected local surgeon who I shall call “T” practicing in a speciality noted for very considerable potential for lucrative private work. He vehemently and passionately argued that private practice was an abomination, promoting inequality and conflict of interest and wanted to have it outlawed. On the other side was a surgeon “A” with considerable private practice arguing the opposite. He was known to be wealthy and it was clear a lot of his wealth had been spent on pies. To the young, idealistic doctor I was at the time I quickly formed the view that T’s arguments were well supported, cogent and came from a man of enormous principal and integrity. A’s arguments came across as spurious, contrived and flawed and A himself, a greedy fat bastard. It left a suspicion and discomfort with private practice that has stayed with me all my working life, even though at times I have practiced in this area.

After over 40 years I have become, if anything, even more cynical about the area. I have seen doctors make dubious clinical decisions clearly where there was a conflict of interest, promoting treatments to private patients that they would not recommend in the NHS, purely for financial gain. I have seen entire departments bitterly divided by the issue of private practice, which worked it’s way into almost every other issue. I’ve seen backstabbing, abuse, harassment, denigration all arising out of the area of private work. I’ve seen doctors deliberately cultivate long waiting lists in order to encourage patients to take the private route, and when Trusts have opted to increase capacity I’ve seen syndicates of doctors press hard to ensure that this work is accommodated at the local private hospital, where they can insist on full private rates to treat NHS patients. Waiting lists became regarded as gold mines.

At worst the system has spawned doctors like Ian Paterson, but for every doctor like him who gets caught and disgraced there are hundreds who practice a lesser degree of the same principles.

I’ve seen good conscientious dedicated doctors have their careers destroyed by vicious but baseless attacks by others whose ulterior motivation arose from a perception that their private income was threatened.

I’ve seen doctors whose competence was highly questionable carry on working because they had the support of colleagues based on financial interdependence.

The happiest, least dysfunctional,  most dedicated, professional hospitals I have worked in were those where private practice was non existant.

So, after over 40 years of experience and reflection, I agree with T. Private practice is an abomination and should be outlawed.