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By Root 903 0

remains a divisive measure when it comes to the accessibility of healthcare. The NHS, however, means that the GP surgery is a bit of a melting pot for everyone. My waiting room can contain the posh ladies who lunch, sitting next to the homeless drug addicts who do crack. In theory, they should all get ten minutes of my time and have equal access to the NHS services available, but, of course, the reality is very different. Obviously, having private healthcare helps to oil the path to seeing the best doctors quickly, but even without paying, middle-class educated patients get a better deal. They ask more questions, are more demanding and are better able to access services available on the NHS. This has to go down as a failing on our part as doctors because we should be empowering our less-demanding and less-privileged patients with the information they need to get the best care available.

There are some wonderful GP surgeries in very poor parts of the country and they do a fantastic job; however, some of the surgeries in poorer areas are run down and unloved, with unmotivated and unhappy staff. The surgery on a council estate I know of is an example of this. It is very busy because there are a lot of social problems on the estate and, as I’ve mentioned, social deprivation breeds medical problems. The staff have been threatened and the surgery keeps getting broken into, which doesn’t help morale. Also there is the issue of money. I’ve talked previously about how GPs make money by hitting targets. This is a generalisation, but middle-class patients tend to be more active in managing and maintaining their own health than more socially deprived patients. This means that they are more compliant with medication and keeping appointments. Motivated healthy patients make it much easier for the GP to hit targets and, hence, earn money. The patients on council estates often have quite difficult, chaotic lives. If they miss their asthma review appointments or don’t take their blood pressure medication, then this directly influences how much the doctors earn.

The reduced earnings of the council estate practice and low morale mean that it can’t attract enthusiastic, dedicated new doctors. There is no shortage of GPs locally but the surgery on the council estate is currently being run by a series of locums. This is because one of the permanent doctors is on long-term sick leave with stress-related problems and, despite advertising, they can’t find a GP to fill the other vacant post. The locum doctors never get to know the patients and as a result are generally fairly apathetic and disinterested. It is the patients who lose out. Middleclass patients would often demand improvements or move to a new surgery, but the patients on the estate often don’t have the means to do this so put up with a poor service. It is yet another example of a two-tier health service. Nye Bevin must be turning in his grave.

Tingling ear syndrome

‘I’m sorry, Paula, but I have absolutely no idea why your right ear has been tingling a bit since this morning. I don’t think it is anything to worry about and it will probably go away on its own. Come back if it doesn’t.’

I spend quite a lot of my time telling my patients that I don’t really know what is wrong with them. This sometimes disappoints them terribly or at least makes them think that I’m a rubbish doctor, but the reality is that I see hundreds of patients with the odd ache or pain or tingle or discomfort and often I don’t really know what is causing it. This isn’t because I’m a rubbish doctor, it is just because we all get the odd funny ache or pain now and again and eventually it almost always goes away on its own. One of my colleagues tells his elderly patients that if they wake up one morning without any aches and pains, they have almost certainly died in the night! When I am faced with my patients’ mysterious aches and pains, I am often tempted to make something up and prescribe a placebo, but gone are the days where we could completely bullshit our patients and get away with it.

My brother is not