By Douglas Kruger
I HAVE a medical question. Actually, that’s not quite accurate. I have a question about our medical modality and how we conceive of it. The question is this: Who ultimately owns a patient’s wellbeing in Jersey? Is it the patient? Or the healthcare system?
It’s a subtle distinction, but one with important ramifications. I’ve seen it come up three times recently.
A friend of ours decided she wanted a vitamin B shot. She asked the doctor for one, but was met with indignant shock. “Goodness, no! You’d have to have a blood test first!”
I’ve had vitamin B shots back in South Africa. Not once did I have to prove that I “needed” it. It’s a good idea, and I wanted one, so I simply paid for it. The end.
Nevertheless, she asked for the blood test, but was met with a second round of pearl-touching: “Heavens, no! We don’t think you need a blood test!”
I’d be tempted to say: “Who cares what you think?” But that’s my framework of perceptions. Hence my question. I don’t fundamentally believe that the medical fraternity owns my outcomes. I believe that those belong to me. I see myself as a member of the community. Not a ward of the state.
She finally got the test done, and it turned out our friend was so vitamin B deficient that it’s amazing she was still standing. She got her shot. But here’s how I think the scenario should have gone: “I want a vitamin B shot. Here’s my money.” Done.
I have nothing but respect for doctors. And on the single occasion on which I’ve visited one in Jersey, I found mine to be exemplary, and a very witty conversationalist.
But who on earth is a doctor to tell you what you can or can’t do, at the level of vitamin injections? Do we entertain the notion that our doctors are “in charge of us”? How utterly bizarre.
Forgive this upstart’s impertinence, but I see a doctor as a service provider. A highly qualified service provider, certainly, with years of hard-won insight. But a service provider. Here’s my money, and here’s the outcome I want, given that you are the most qualified guide to get me there.
Malcolm Gladwell touched on this theme in “Outliers”. He noted that in the US, poorer families typically taught their children that a doctor was “an authority figure to be obeyed”, whereas wealthier families taught that their kids that a doctor was “a resource to be utilised”. It’s the difference between “The doctor is in charge; do what he says” and “The doctor is here to answer all your questions; ask what you want”.
Second example. Another friend of mine had a personality clash with his doc. Just didn’t like him, that’s all. It happens. So he asked for another. I find that perfectly routine. They didn’t. “How strange, sir! No, we couldn’t possibly do that!”
When he returned a year later (and had to see the same doctor), there was a note on the system stating that he was unhappy with his physician. The receptionist asked him if he still wanted the note to remain.
How embarrassing.
In many other places around the world, if you ask for another doc, the response is essentially “Hey, it’s your dime” and that’s the end of it.
It would make for a good investigation. Not a witch-hunt, by any means – I’m not making an accusation here. But perhaps an intriguing inquiry. How exactly does our medical fraternity perceive themselves, their place, their role? What is their assumed level of ownership? How do we think of them? What is the nature of the relationship?
Perhaps it’s part of an inherited culture. We’re not part of the NHS here, but we nevertheless share essential British culture. Perhaps the framework of perceptions is the result of socialised healthcare; basically: “The system takes care of us.” But the system is still using our money. We are not grateful beggars in this equation. We are the taxpayers. Right? Would we see the relationship differently if the system were pay-to-use? It’s intriguing.
Third example: The birth of a baby. Protocols govern the order of proceedings. But what if that doesn’t suit you, the new mom? You are told when you may have first contact with the baby. Fine. But that’s doctor-centric. Absent an emergency, should a new mother be “told” when they may meet their perfectly healthy child? Isn’t that her choice?
If not, then the implication is that she is owned. That the baby is owned. That the process is owned, as opposed to “facilitated”, by the medical fraternity. And sure, it’s extremely benign; ownership “for your own good”. But if we keep up that line of thinking, next thing we’ll accept being locked up in our own homes during a viral outbreak, and wouldn’t that be a travesty?
Of course, new moms are incredibly vulnerable at that moment, and it’s infinitely easier to take instructions than to give them. But here’s the acid test: could a new mom, in principle, hear the instructions and respond “No”?
Granted, things can also go too far the other way. Witness the Oscar winners who will wail for an ambulance over a sprained ankle. Scrambling a medical team for a stubbed toe takes ownership of healthcare to abusive levels.
It’s wrong to milk a system unnecessarily. But it also seems wrong to transfer ownership entirely to that system. So maybe the question isn’t, “How do doctors perceive themselves?” Maybe it’s: “Where are the limits of authority, in the case of a requested service?”
Ultimately, someone must be in the driver’s seat. If the prevailing belief is that it isn’t the individual patient, that might be cause for concern. And possibly, a rethink.
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Douglas Kruger lives in St Helier. He writes and speaks for a living. His books are all available via Audible and Amazon. Meet him at douglaskruger.com.
