How not to be a Doctor

When I read this article earlier in the week, I found it hard to believe that a doctor, in the UK in 2014 had actually put the words to paper. More so that anyone had given him the space to express them in public. First I checked that it wasn't an old article from the 40s or 50s. Then I checked it wasn't a spoof site. http://www.cps.org.uk/blog/q/date/2014/09/12/illness-as-a-career-choice/

But no. The author claims to be a currently practicing physician. It's hard to believe, in fact, that he isn't Iain Duncan-Smith in disguise.

Let's start with

"a common driver to ill health is the welfare state. In short, it appears that being sick has become a way of life and a career choice for a worryingly high percentage of the population."

A remarkably static 2.5 million people in the UK claim an out of work benefit due to sickness or disability. They are not the same people, rather people come on and off the benefit as conditions appear and subside. That's less than 3% of the population. Presumably our doctor author doesn't think ALL of them have simply adopted cancer or Parkinson's as a "career choice" meaning that less than 2% is a "worryingly high percentage" in his world. It may be best if we disregard any further maths related claims he makes.

He goes on to tell us that

"Two patients can have identical pathology but with striking differences in illness behavior."

Lets take a look at that shall we? Take one man in his mid 50s living in Surrey with diabetes. He has private healthcare, a comfortable home, a supportive family and can afford an excellent diet and membership to his local gym. His diabetes is under excellent control. Another man the same age with exactly the same pathology lives in Glasgow in poverty with no family or assets. He cannot afford to eat well and finds it very hard to exercise without support and encouragement. He becomes depressed and his diabetes is unstable and poorly controlled

Sadly, our doctor friend can only see the world through a medical prism, so none of those things matter. What's more, given his income, lifestyle and opportunities as a doctor, he is much more likely to identify with the first man than the second.

Now, I wouldn't want you to think that the good doctor is basing his judgements on anecdote alone. No, he refers to

"One informal survey of colleagues from around the UK placed the figure [of malingerers] at between 10% and 90%."

Phew, that's OK than. We have an "informal" survey with an 80% margin of error. I'd hate to think we were just making things up as we went along.

The next section of the article aims to make the case that we should return to a system in which the patient not only has no say in outcomes, but is actually not kept informed in any way. If a doctor has to show a patient the report he writes on their employability, he will apparently be too scared to be honest. Far better he should be able to write what he likes about the patient, whether accurate or not and the patient should have no opportunity to either see what is written or to confirm or deny it's accuracy. He is convinced we should return to the days of "doctor knows best" and clearly, he could never possibly be wrong. His opinion only affects the entire livelihood of the individual he judges, after all, why should they have a say?

He is certain that people do not complain because he or his colleagues ever get things wrong, but because they don't like their conclusions. Allowing a patient to see what he has written might cause them to disagree with him and that would never do. Clearly, the only reason they may ever disagree is because a comfortable life of luxury on a whopping £101 per week might slip from their grasp. He could never actually be wrong.

But the part that terrified me the most, the part where I stopped laughing at his archaic views and "quaint" paternalism, was in his 3 suggestions for improving the system of disability assessment at the end of the article. (Incidentally, he regularly conflates long term illness with disability, but I'm sure it was unintentional....)

His 2nd of 3 suggestions was that

"if a patient were wheelchair-bound but had full mental faculty then financial support would be provided to assist with mobility only if they were active in terms of work"

So let's say you have cerebral palsy or quadriplegia. In the world of our Dr Certainty, the only thing they need to get work is "full mental faculty". Whether they have constant infections or regular falls or seizures or uncontrollable limb spasms or any number of other related challenges to overcome is irrelevant. If they can think, they can work or they deserve to be prisoners in their own homes indefinitely.

Think about that a bit more. It also means that every one of those ppl he would consign to life of isolation and almost certainly great poverty, is able to get exactly the same education an able-bodied peer might get. Transport, access, and almost everything else in life most take for granted would have to be just the same for the person living with an impairment as for those who do not. It would have to take them the same amount of time to achieve comparable tasks. What's more, it would mean a society that never discriminates against employing a disabled person over someone without a disability, never allows disability discrimination in the workplace or place of learning, and that never indulges in hate crime or bullying. But Dr Certainty appears not to have thought of that.

So let's turn the Dr's own question back to him. How is it that 2 Drs with identical qualifications and clinical experience can come to totally different opinions of their patients? How is it that one can see the whole person, taking into account education, wealth, opportunity, mental state and family circumstance, while another can only see a diagnosis?

Perhaps if the DWP spent as much time weeding out judgmental, paternalistic, ignorant, potentially dangerous Drs as they do seeking mythical hoards of supposed benefit cheats, the health of the nation might improve dramatically.