Sunday, 14 September 2014

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.

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.


  1. I haven't stopped thinking about this since reading it. I wonder what the MS society makes of it?
    Wonderful piece Sue..Thankyou

  2. The 'doctor' recommends that people with mental health issues should be made to do manual labour or become befrienders to old people. He/she doesn't account for comorbidities or realise that having a mental illness is physically debilitating. His/her idea of encouraging vulnerable people to support other vulnerable people, without even considering that the first group of vulnerable people may be too vulnerable in the first place to perform such service, is frankly laughable, and demonstrates a complete lack of knowledge about mental health. This doctor practices in the northeast and seems to believe it is awash with 'doleites' because in his/her view all the healthy talent has migrated to the southeast and all the 'sickies' have moved north in some kind of health/wealth tradeoff, no doubt organised by the Illuminati if this tosh is to be believed. With that laserlike insight, it is a wonder this amazing doctor still chooses to remain amongst us dole dossers, cripples and malingerers, especially since there's less money to be made off us up here. I get the sense this doctor resents having to treat patients who don't shop at Dolce & Gabbana. God forbid anyone listens to this uninformed fool, but seeing as uninformed fools currently run this government, this physician's 'ideas' will probably be lapped up as 'expertise' by Westminster.

    1. I'm sure it wasn't your intention, but you made me laugh with your spot on disdain

  3. iAs a claimant he scares me, as an ex benefit worker he makes me angry beyond words. Nobody chooses to claim, as a lifestyle choice, and live on a pittance. Many have a long fruitless fight to claim what they are legally entitled to. Some just won't claim because they read idiot speak like this, and as a result, be put at serious risk. He should be struck off to protect patients.

  4. Debbie - There was so much I could have written. ALL evidence shows that people are the best judges of their own impairment, they work longer than they should before claiming, often making themselves more unwell and they go back to work sooner than they should. Dr Certainty has clearly had little time for evidence for most of his career.
    Pissedoff2011 made me realise I had assumed the author was male. Of course that may have been wrong, but there's just something about the tone and language that makes me think I'm not.

  5. Excellent... as ever.
    On the subject of doctors being 'right', I had this experience a couple of weeks ago... I think it speaks for itself?

  6. I'm sorry Sue, but you appear to have been taken in by a hoax.

    Or at least I really hope that you have.

    1. Hoax?

      Check out GP Newspaper

  7. People like that doctor worry me. I was left in unbearable pain because medical (un)professionals did not believe me. Repeated cycles of physio that made me worse and when I said I felt terribly sick it was ignored, I did not eat before because I was sick afterwards. I was discussed behind my back (my doctor admitted as such, luckily he at least was honest), I was treated as if I was mentally ill until I demanded to see a Psychiatrist who thankfully agreed that I was not mentally ill, my notes were lost repeatedly, one specialist and his staff were rude to me (I was told to lose weight and get a life) and caused me terrible pain which was needless, they were trying to catch me out as if i was a liar even though they had my scan results showing spinal damage, they didn't know who was my surgeon the day before I was to have surgery but it did not matter because by then it had become inoperable, they lost my referral, I had questions about my sex life that I was bullied into answering (a work injury at a factory does not have anything to do with my sex life) just to see the pain clinic (the referral was missing for over a year) and being told there was nothing helpful they could do. So now I am mentally ill, I have depression and anxiety. I live in unending unbearable pain and I know that if I am ill with something else that all this could happen again and I don't think I am the only one who has gone through this. Don't worry though because the NHS deny everything, no matter how much damage it causes.

    How many malingerers are people who are neglected and in need of proper help?

    1. Sorry to that you had to go through all that, it's inexcusable. Have you tried Tapentadol for pain I highly recommend you try it if not? I hope you do not have to go through anything like that again.

    2. Thanks it is very kind of you to respond. I am on a few different medications and compared to how I was originally I am about able to cope. I have a different doctor and he does seem to understand. I hope no one has my experience but some do and worse, I am lucky compared to some people because this was a few years before ESA and the bedroom tax and my family helped me. I just hope the doctor who did the lazy survey could realize the harm of his generalizing of potentially very vulnerable people.

  8. Brilliant piece, Sue - just feel sorry for that dinosaur's patients !

  9. "To question the unquestioned, think the unthinkable, blaze new trails, talk bollocks..."

  10. The whole thing just makes me angry and at the same time is frightening. It's like the government has anyone and everyone disabled backed into a corner with no way out.

    I myself have a fair few things wrong with me and have been disabled from birth, I had the misfortune of having to explain to an Atos assessor what my conditions were, she had no clue. Even the most basic of basic things. Sure enough I failed, no money for months, appealed and got Support group status. These kinds of things just shouldn't be happening.

    If someone is disabled and has a lot of documents proving this, leave them alone, why put them through all this stress? It's sick.

  11. Check out GP Newspaper if you really want to be disillusioned

  12. He is not saying there is no such thing as ill health. When Thatcher moved loads of people from unemployment benefit to an invalidity type benefit she wanted to keep the unemployment figures down. There is such a thing as the sick role.....some people slip into this very easily and it's bloody hard to convince people they are not ill or not that ill. It's a learned helplessness. You must all know about deaf people who hear what they want. People with arthritis who can do the garden. I am not talking benefit scroungers who are only 1% of claimants. There are many people in hospital who could do more for themselves. I once nursed a 35 stonean who couldn't get out of bed and had to be turned and lifted out of bed. On discharge he got up and walked off the ward didn't wait for the stretcher or ambulance. Our backs were breaking.....that is someone throwing themselves whole heartedly into the sick role

  13. "Then I checked it wasn't a spoof site."

    Well, Wikipedia describes the CPS as "a free-market neoliberal British policy think tank", so only just not a spoof site.