Prescription for customer relations if not exactly care
Published in Tribune, 3 August 2007
RARELY has a disciplinary meeting of the General Medical Council attracted such attention. Dr Andrew Wakefield, who originally blamed the MMR vaccine for autism in children, stands accused of multiple counts of serious misconduct, alongside two of his former colleagues. He is accused of failing to seek ethical approval for studies, breaking ethical guidelines, dispensing inappropriate treatments to his young patients, being dishonest to both the journal The Lancet and to the British Medical Association regarding aspects of his research, working with children without having the necessary paediatric qualifications and paying children at a birthday party to give him blood samples for research.
He is also alleged to have received payment from the Legal Aid Board for work in support of parents who were challenging the vaccine in court – a conflict of interest he did not disclose, either to the hospital ethics committee or to The Lancet when he published his research.
This is quite a list of charges – and if the hearing finds against him, Wakefield risks being struck off. The hearing is, of course, ongoing, and Wakefield, who denies wrongdoing, is innocent until proven otherwise. Nonetheless, there is something fascinating about the hearings. Despite the serious charges against him, the two groups who might be expected to abandon him first – the press and the parents of the children he works with – have stood by him.
The media were always supportive of Wakefield – and not just the yellow press and health scandal-obsessed Daily Mail. But that was before the detailed accusations against him were publicised. Given how newspapers usually crucify anyone accused of the slightest misdeed against children, it is perhaps a little surprising that they have not yet turned against him – but one thing the press has never been accused of is being consistent. The story of a lone doctor battling against the corrupt establishment makes for good copy – especially if you can suggest he is daring to tell the truth while dark forces are trying to silence him. What is more interesting is the support of the parents whose trust Wakefield is accused of breaching. A phalanx of them greeted him outside the hearing on the first day, holding up supportive placards and chanting: “There’s only one Andy Wakefield!” It is clear that to many parents, he remains a hero.
Regardless of the merits of the case – and Wakefield may still be cleared on all counts – the way the doctor has built up such a loyal following should teach us a lot about what is wrong (and what is right) about our health system. One of the most telling quotes from the pro-Wakefield camp in recent weeks came not from one of the strident MMR critics in the press, nor indeed from the controversial doctor himself, but from a mother interviewed (where else?) in the Daily Mail. Wakefield, she said, “was the only doctor who listened to us, who took us seriously”.
Britain, by international standards, has quite an unusual healthcare system. Despite the reforms of the past 15 years which have seen Nye Bevan’s monolith split up into a patchwork of trusts, foundations and fundholders, the NHS remains, culturally and financially, a centralised institution, with a clear flow of money (and influence) from the top downwards. This, despite our moans about overpaid hospital managers, makes it rather efficient: in terms of the money we put into it, Britain has an excellent health service. But its set-up has a profound effect on the relationship between doctors and patients.
In most countries – including those, like France, with universal healthcare – the GP is chosen by, and is answerable to, the patient. There is a consumer culture, and that breeds expectations of a certain level of service. In Britain, the doctor is, to all intents and purposes, employed by the government, and the patient is a passive recipient of whatever the NHS decides is appropriate treatment.
As anyone who has fallen ill while on a holiday to France will know, the patient experience there is quite different – far longer appointments even for minor problems, weekend and evening opening, unrestricted home visits and the choice of surgery to go to (with no need to register or even phone ahead).
The British Government has made big noises about bringing “choice” and a consumer culture to the NHS. Based on the French experience, this seems like a no-brainer. Unfortunately, though, the focus has been on painful, expensive and ultimately pointless reforms in hospital medicine, rather than relatively simple changes to the way GPs’ surgeries work, which would transform our relationship with the health service.
The reforms seem odd. When a customer wants a new television, they might expect a range of electronics shops to visit, with knowledgeable staff. Yet, in effect, by introducing choice in hospitals, but not with GPs, what the Government is offering is the equivalent of a flight over to China to choose which factory the TV is made in, while insisting that they must still buy it from a single approved supplier with potentially rude and unsympathetic (or just plain overworked) staff.
Wakefield might be a dodgy salesman – but the NHS could learn a lot from his customer relations.
