Sunday, 6 January 2008

Buy Your Tickets Here

For the post code lottery,

I recently read this post on the Guardian by a medical student. Mr Thomas (a pseudonym) raises some interesting points but he does so with an exceptionally poor attitude. Judging by some of the other things he has written for the Guardian his attitude isn't a one off. Honestly I wonder how some of these people get into medical school in the first place, I've heard a number of stories recently at various medical schools of students with awful attitudes, in some cases directly towards patients on clinical placements. I wonder how far they have to go before they get kicked out! I know I can have an attitude at times but NEVER towards patients, it is my view that all patients are as important as each other and they should all be be important to me, or you, as a doctor. Mr Thomas however, makes a point that he doesn't care about so-and-so receiving expensive treatment as long as he gets to go home early. It might be fine as student to be able to go home early but once qualified, it should be his patients that come first, not his desire for an early finish.

Anyway, now I'm done ranting I can talk about the actual article: "Expensive Drugs On The NHS Are Not A Right"

Fundamentally Mr Thomas makes a good point, that there is only a finite budget available for the NHS and this must be distributed sensibly and fairly. At the end of the day, things like this always come down to money and as we all know the NHS isn't founded on an orchard of money trees. There always has to be a line and unfortunately some people are always going to be on the wrong side of this line. The important thing is who defines this line and how do they do it?

Basically it comes down to assessing how much quality of life, and how much an extra year of life are worth. This is impossible to accurately quantify, not only does each person differ, but it is morally impossible to put a value on life. Nevertheless this is the way things must be done and is the way they are done when deciding if treatments are worthwhile. The people that fall on the wrong side of these decisions are always going to have a case for challenging that decision. But at what cost? They take the NHS to court (rightfully or wrongly, you decide) which probably costs thousands of pounds. If they win, they get their treatment but at the expense of someone else, the NHS having spent money defending their case which could have otherwise been spent on patient care. If they don't get their treatment they are left feeling hard-done by and the NHS is still out of pocket. There can be no winners in a situation like this!

An important factor which makes this story a media favourite is the fact that regulations often differ depending on your post code. One person living in one town might be entitled to the £10,000 treatment which might improve the patients quality of life. Just down the road in another town, a similar patient might not be. Now this isn't fair, if there is going to be a line then that line should be the same for all patients throughout the country, this might be difficult sometimes as each patient is different but it is morally wrong to discriminate based on post-code. This is the reason we often read about patients going to court seeking their treatment and perhaps they are right to do so. Guidelines need to be standardised before we can defend the decision to withhold a treatment due to cost.

What do I think about these expensive treatments? I don't know enough about them to comment. I would imagine each patient has their own case. It is hard to decide who gets the treatment and who doesn't but unless the NHS finds a way to print its own money, these decisions are always going to have to be made. Is there a solution? I don't know.


dr_dyb said...

Medicine is all about prioritisation. From Triage in A+E to waiting lists, to Trauma theatres, to booking a GP appointment.

The NHS is by its structure a resource limited framework for health. Thus rationing is inevitable. How we ration what gets into some nice pghilosophy - The greatest good for the greatest number"; "Preserving a life at all costs".

The american model is simple - you can have healthcare as long as your insurance will pay for it. After that you can get basic care on the state.

It is an interesting issue, and ever more the decisions about who to treat are being removed from the clinical doctor and QALY analysis and being taken by managers.

Emma said...

Unfortunately I don't think their is an answer but I do agree the decision shouldn't be left to individual PCT's and should be made as a national one, at the moment it is done on each individual case and the local PCT makes the decision on whether to agree to it or not.

I do agree though most cases do get agreed as soon as the media gets involved but at what cost to others has to be the question I would ask...

Thanks for visiting me, glad I found you too..x

the little medic said...

dr dyb - The fact the decisions are being taken by managers is perhaps one of the main problems. Managers cannot assess an individual patient's needs.

It is quite the philosophical can of worms - a bit deep for me and my blog methinks.

emma - Yeah, I don't really think there is an answer either.

Thanks for visiting.

dr_dyb said...

Sadly with us medics there is also the ego factor - spending more money on patients we like, or who have interesting cases, or non-self-inflicted diseases!

fi said...

Perhaps it's time to go to the root of the cause: The pharamceutical companies who produce and patent the drugs and charge extortionate sums for their use. Yes, they have to make a profit in order to ostensibly research and develop new drugs, but do they need the profit that they actually make? In the first two quarters of 2007 Glaxosmithkline had a turnover of £5674 million, which, while not all coming from its pharmaceuticals, can still be called a significant profit in the face of people dying.

Elaine said...

That is a very sensible and well thought oout article, little medic. It is very hard to convince the public (never mind the media) that the NHS has limited funds.

(particularly when they see all that money being spent on IT and managers).