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THE COMMERCIAL IMPERATIVE ALTERNATIVE

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 in our Practice and was reflecting in the quiet time before I took over from my colleague Angela. I smiled, remembering her enthusiasm when she finally achieved her coveted post-graduate qualification, the Diploma in Explanation and Analogy. She was clearly destined for greater things and I could already visualise her considered eagerness in our local Communication Superskills Group chaired by my respected colleague, George, Dean of Local Development.

My last regular meeting with George had been up to it's usual standard. “Yes Alex, I'd like to discuss the feedback from our older patients, they seem to like your explanations and support” was his opening.

“That's grand, but what about the other groups?” I replied in the full knowledge that some gem of insight was coming my way.

“Well you haven't had any positive responses at all from our ultra-fit sub-group” he replied “and you seem to spend comparatively less time with them”

“Really” I said in my best daft laddie style, knowing well that this was indeed the case and that I had already flagged the matter up for the next meeting of the Superskills Group.

“Had you thought of how to approach it with the Group?” came the seasoned reply.

“Hmm, approach it with the Group” I replied, letting the reflection hang in the air.

No one out-reflected George. “How about some learning time before the meeting to assist you and the group?”

I readily agreed, thoroughly enjoying a lifetime of consultation skills and reflecting on Trish Greenhalgh's wisdom of education for capability¹. I was happy to work in our NHS and this early wisdom had improved my abilities to adapt and respond to a supportive but rapidly changing environment.

My reflections were gently interrupted by the arrival of my first patient. Mr Bill Johnston was in his late twenties and enthusiastically handed over his combined health card, which confirmed his Ultra-fit status and listed his previous medical issues along with a calculation of his most common health risks. He was absolutely clear in his request.

“Hi doc, I'd like to talk about that tablet Cardiogon, the one that apparently reduces my risk of a coronary by 41%. I've read a bit about it and wonder if it's for me”

“I can't remember you dad, uncle or Grandpa having heart disease, is that your understanding too?” I enquired gently.

“No, you're quite right, but I'm really keen to stay healthy and wonder about reducing my risk by 41% like the advert says” he replied showing visible signs of interest.

“Well” I replied, “How common do you think a heart attack actually is in your age group?”

“I don't suppose it's very common” he replied as the concept of absolute risk crept into his consciousness.

I tapped the computer and revealed that the risk for his age was 2.1 per thousand and his individual risk was 0.72 per thousand.

“So basically Doc, you'd need to treat about 500 people with Cardiogon to have any effect,” he said, emphasising the 500.

“Spot on Bill, you've got much more chance of having a serious side effect with Cardiogon than you have of a coronary” I replied basking in his insight

“Excellent Doc, I've been struggling with this one- I'll put in a good word for you!” He said laughing. Oh well, another meeting with George I suppose.

It all seemed so far away from the days of our own surgeries when small groups of struggled to give an honest service to those patients who needed it, regardless of their social status and earnings. I work with our NHS and love our sign proclaiming that we're proud to belong to it. It seemed incredible that we've grasped cost efficiency and have budgets rolling over five years. I reflect in wonder at these changes and advances around a working core of compassion.

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.