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THE COMMERCIAL IMPERATIVE ASSASSIN

By Alex Thain
Contact the author by e-mail at info@ardlarich.co.uk

“Don't it always seem to go
That you don't know what you've got
Till it's gone”
Joni Mitchell - Big Yellow Taxi

One coin,
two sides

The last episode of hoolet seemed to be a written crystal ball with opinions, fears, concerns and reminiscences in equal measure. Not all are right, not all are wrong but all are valid. Despite the fact that we exist in a professional environment that many would wish to control, we still retain a significant measure of free will. Of course, responsibility comes with free will and I fundamentally believe that we can, and should, market our profession to those who wish to change it and particularly those who may wish to follow us. It isn't advanced calculus to find a correlation between endless carping and reduced retention. Our deeply personal involvements with patients and their families offer us an insight and privilege denied to most other professionals. These involvements are often hard and prolonged but generate a connection to other human beings that we should celebrate and nurture as part of our vocation. I know that this sounds flowery and grandiose and represents a small part of our work, but we must tell others about it - go forth and market!

The following pieces represent alternative futures, polarised for effect - how do we steer our craft to our future whilst preserving our precious cargo of compassion?

It was an ordinary day in an ordinary surgery in the north of Scotland. It was Thursday 18th of March, 2027.

I'd come to work my shift for Marks and Tescmart (providers for all your needs) and was reflecting in the quiet time before I took over from my colleague Dr Somerfield. I smiled, remembering her enthusiasm when she finally achieved her coveted post-graduate qualification, the Diploma in Retail Health Care. She was clearly destined to move to one of the company's bigger sites and had aspirations to become a Regional Health Care Team leader.

My own meeting with my Regional Health Care Team leader had been up to it's usual standard. “Yes Dr Thain, I'd like to discuss the customer feedback from our “value” customers, they seem to like your explanations and support” was the opening from the serious young man.

“I' m sorry, I don't quite see the problem” I replied in the full knowledge of the marketing anathema.

“Well you haven't had any positive responses at all from our “ultra” customers” he replied somewhat curtly.

“Well call me an old man who's working away in his 67th year, but I haven't had any complaints from the Ultras and the Values seem happy so I'm clearly still missing the problem” I said in my best daft laddie style.

“The problem Doc, as you well know, is that we only make a marginal profit on the Values and you seem to attract them- your unit profitability is falling. This isn't the old NHS you know, there's nothing in your contract about compassion” came the acerbic reply.

“Hmm, nothing in my contract about compassion” I replied, letting the reflection hang in the air “Perhaps it's a basic human characteristic…”

“Look Doc” he said cutting across me, “it's a business, our Government has decided to root out the inefficiencies of the old GP system and passed it over to us to run efficiently. We decide what the customer can have.”

I stayed silent, thoroughly enjoying a lifetime of consultation skills and reflecting on Trish Greenhalgh's wisdom of education for capability¹. Marks and Tescmart, the giant retail conglomerate, certainly necessitated my learning of different skills and this early wisdom had improved my survival skills no end.

My musings were definitively interrupted by my first customer. Mr Johnston was in his late twenties and dutifully handed over his combined loyalty/health card, which confirmed his “Ultra Plus” status and listed his previous medical advice along with a breakdown of his subsequent purchases from the M & T Goodheart! range. He was absolutely clear in his request.

“Listen doc, I'd like that tablet Cardiogon, the one that reduces my risk of a coronary by 41%. I've read all about it and it's the one for me”

“Do you have any history of heart problems or is it in your family?” I enquired gently.

“Does it matter Doc, I just want to reduce my risk by 41% like the advert says” he replied becoming ever more irritable.

I persevered, desperately trying to help him with the concept of relative vs. absolute risk “How common do you think a heart attack is in your age group?”

“Well it doesn't matter Doc 'cos it'll be 41% less with Cardiogon, won't it” he retorted, indignation rising like the sun.

I tried one last time “Mr Johnston, you've got much more chance of having a serious side effect with Cardiogon than you have of a coronary” I replied as carefully as I could.

“Right, that's it, I'm heading off to Lidl and Waitrosson, they've probably got Cardiogon on offer anyway” he shouted, slamming the door loudly. Oh well, another meeting with serious young man I suppose.

References:
1. Sarah W Fraser and Trisha Greenhalgh
Complexity science: Coping with complexity: educating for capability
BMJ, Oct 2001; 323: 799 - 803. Return

And the alternative?

Other hoolet online articles by Alex Thain can be found at:
hoolet edition 50 - A Fairy Tale
hoolet edition 49 - A Tale of Two Addicts
hoolet edition 48 - The Supporter
hoolet edition 47 - Cannon Fodder
hoolet edition 46 - The Commercial Imperative Alternative
hoolet edition 46 - The Commercial Imperative Assassin
hoolet edition 45 - A Lateral Thought
hoolet edition 44 - The Watching
hoolet edition 43 - The Child Within
hoolet edition 42 - If Kipling were a GP
hoolet edition 42 - Of Directors, Philosophers and Poets
hoolet edition 40- Of Knees and Knickers
hoolet edition 39- Neighbour meets Norton
hoolet edition 38- Embarrassment
hoolet edition 37- From the Book of Negotiators
hoolet edition 36 - Practice Visit By WH Audit
hoolet edition 35 - The Bells, The Bells. . . .
hoolet edition 34 - Talking Urine
hoolet edition 33 - Reflections on Reggie Perrin
hoolet edition 32 - Myth 1 Logic 1
hoolet edition 31 - Poems
hoolet edition 30 - One Size Fits All
hoolet edition 29 - Downwardly Mobile
hoolet edition 28 - From the mouths of babes
hoolet edition 27 - On Losing Their Child

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.