Sunday, February 05, 2006

We Know Not What We Ask

This Telegraph story about the new government proposals to offer everyone an MOT at five points in their lives in order to assess their fitness, (incidentally by old friend Alice Thomson)could be instructive in several ways.

First it demonstrates this current government's almost admirable ability to directly contradict themselves within the space of a sentence. Take Patricia Hewitt's "People don't want nannying or to be told what they must do but they do want more information, advice and support."


But this irrationality unfortunately is not entirely Ms Hewitt's fault. Although, apparently, people don't want nannying "more than three quarters of 1,000 people who took part in a "citizens' summit" in Birmingham last year said they would like a regular health check".

And so it is with many of the government's encroachments. We call for it ourselves without really thinking about what it all means. Despite the fact that there is hardly a single mother I have ever spoken to who doesn't in some way resent the intrusions of the health visitor, we blithely call for more intrusion, more nannying, all the while saying that this is not what we are doing. And let's face it too. Just how useless is this initiative going to be! Useless, expensive, pointlessly intrusive - so very much on form then.

These calls for coercive intrusion happen all over the place, usually in the guise of solving the problems of the world. If we all gave a certain percentage of our income we would solve the problems of poverty, etc, etc. We must just stop and think what this will mean.

(There are other direct contradictions and a good dose of ridiculous irrationality demonstrated lower down in the article, eg: GP's are meant to become more responsive to patients, and yet they are being told more and more from the top what they are meant to be doing...errgh...stop it, that's enough).

One of the many reasons why I so love home education is that the society is entirely voluntary, it forms spontaneously as a result of meeting the needs of individuals, and nobody is compelled to be involved if it doesn't suit them. We do take care of one another, sometimes extensively and in many different ways, practically and emotionally. It does work. More of this please...I know what I am asking.


Anonymous said...

Not intentionally playing devil's advocate (!) but am not too sure that I can see on first reading what is wrong with the proposal.

Firstly, it is optional and secondly, as Hewitt says,
"People don't want nannying or to be told what they must do but they do want more information, advice and support,"

Personally, I was SO glad to see the Health Visitor after giving birth to my first child as I had absolutely no idea what to do and had never had anything to do with a baby before!

Also, doctors always make me feel guilty (and often behave as if every one is wasting there time too unless they are about to drop dead!) if I go there just for advice or reassurance. Therefore, if the doctors are 'supposed' to be offering this service it would make people like me feel a lot better about checking out the creaking knee or something that might be serious but equally well might be nothing.


Carlotta said...

Hi D,

I think you are right to point out the apparently non-coercive nature of the plan as far as patients are concerned, but I wonder how far this non-coercion will generally play out.

It is usually the case that when GPs are on the receiving end of government initiatives, that they are required to do a certain percentage of the practice numbers in order to get the cash. This results in the pressure that nuns and other celibates are put under to have the smear test.

Also, of course, the whole thing isn't so non-coercive if you don't like paying your taxes.

In addition, GPs don't stop resenting extra work just because they are told to do it. I doubt if this will make many GPs very much more helpful.

Plus, GPs already do a massive amount of preventative work in the day to day consultations. They already take BPs, do urine tests, family histories, do smears, breast exams, etc, etc.

Then there is the fact that the regular checks are so unlikely to make a significant impact upon the way people really live their lives that it would just amount to a huge waste of cash.

Everyone surely already your veggies, take exercise, don't smoke...what else would we really get out of this? They aren't going to do an MRI scan or a blood test for anything other than the very basic stuff that a Practice Nurse already tests for.

GPs are usually already squeezed pretty hard trying to be responsive to patients as and when they need it. It doesn't help to hand down broad centrally planned initiatives that are going to be very expensive to implement (all those wasted canvassing letters that have to be written and posted, all that bureaucracy), when this could be managed already between the GP and the PN.

All GP led preventative measures so far have shown very dubious results. Why perpetuate this expensive waste? called.

Clare said...

Just to add to your list of things that GPs coerce their patients into doing in order to get cash...vaccinations??? Grr!


Anonymous said...

Well that certainly clears that up! It's interesting to get the GP/health carer's point of view. But, still have to question, Clare, whether or not they actively coerce people?!

I certainly never felt or was coerced by the GP...


Carlotta said...

The question of coercion does come down to the individual practioner in many instances, but the central directive nature of many of the intiatives means that GPs are more likely to be less sensitive to the individual patient and more likely to try to push to achieve their margins.

GPs also often feel coerced by these government-led initiatives which do not necesssarily meet local GPs in and around the Cadogan/Sloane/Eton Square areas of London where virtuatlly every over 75 year old would have Picassos and the like hanging in their bathrooms, would still have to offer the over 75 check. Simply offering these checks was a totally unnecessary drain on NHS resources. Actually performing them, which did happen, was just totally ridiculous.

Clare said...

I've heard some MWs/HVs/GPs be awful to people who choose not to do what they think is best. A mw told my friend that if she insisted on planning a homebirth they'd get social services in - if that's not coercion, I don't know what is! What about all the letters I've been sent telling me to get my daughter's MMR done, despite me asking them repeatedly not to bother! Carlotta's right, it does come down to the individual practitioner - my old GP was wonderfully supportive of informed choice and respected our decisions whether they agreed with his ideas or not. I also had an amazing midwife. But coercion certainly goes on very commonly in the health service - in hospitals as well. As a nurse I've seen patients being cajoled and threatened into having treatment that they don't want - paternalism is how many doctors and nurses work - I'm sure Carlotta will have seen similar things. Probably laboured my point a bit - have you seen Bodies? If so, I can promise you it is very, very true to life and that illustrates perfectly the pressure on HCPs to coerce their patients into doing what they/the gov/the NHS want.