Page last updated at 12:07 GMT, Wednesday, 21 January 2009

Scrubbing Up: Your Comments

In this week's Scrubbing Up, John Black, president of the Royal College of Surgeons, says the doctor-patient relationship has been damaged.

He argues that a single consultant should once again oversee a patient's care to prevent the important patient-doctor relationship being eroded by a system that he describes as a factory production line.

What do you think? Here are some of the comments you have been sending to this week's Scrubbing Up.


How timely an article! I had the news this week that I need surgery, and as John Black, president of the Royal College of Surgeons, stated, it was an unsettling moment in my life. I fully support the principle of "Patients Choice", but only if everyone is given access to the right information, tools and support to make a properly informed choice. I am a young-ish, PC literate, IT professional, but I am far from convinced of the merits of the new computerised "choose & book" system. I may know my way around a PC, but I have little to no knowledge of any of my local hospitals capabilities, specialisations and reputations, let alone the particular merit of one institution or specialist for a particular treatment over another. We may all need to be a little more accountable in our lives, but sometimes, especially in unsettling times, we need a little help and perhaps even some re-assurance, from those who know the complexities of the system, and the capabilities of the people involved. This unfortunately is not something the new computerised "choose & book" system can deliver. So now we have choice, but how do we choose, and does it make me feel any better?
James Harkin, London UK

The primary concern, above speed and choice, should be the quality of the care received by the patient. Too often in the NHS achieving the targets becomes the priority and patient care suffers as a result.
Ian, Nottingham, UK

What patients need is more information and more choice, not less. The current method of patient referral certainly has its problems. But the traditional method espoused by John Black did much more to support and conceal bad surgeons. In truth, the real motivation behind Mr Black's argument is all about restoring status and power to doctors and reducing scrutiny. Doctors don't think of themselves as normal people, they don't like being accountable and they particularly loathe being seen to provide a service, being called out on the quality of that service and subsequently instructed how to improve upon it. I'm sympathetic to his broader concerns about the abuse of targets and similar bureaucratic tools. But patients everywhere should be extremely suspicious of any proposal that reduces the amount of information and control at their disposal.
Jeremy Laird, London

One doctor One patient for continuity. By the time consultant B,C,D ETC have read your notes the consultation time allotted has been halved or more.
Linda Cairns, Dunstable, Beds

I totally agree with every word of this article, and its conclusion. The personal aspect is more important than the statistics.
Beatrice, Wilmslow, UK

I would entirely agree with the comment made that 'It should again be the norm that patients are referred to an individual consultant who will be responsible for their care throughout the clinical episode' Speed, in this context, can be a recipe where the likelihood of mistakes can lead to disaster. Most of us rely on our GP to make the best choice of who to refer us to and would be lost without him/her doing so. I would rather be treated as a human being than a cog in a wheel.
Peter Armon, Brighton

Wholeheartedly agree. I know as a GP that one of the most important parts of the healthcare of my individual patients is unmeasured and unaudited - the rapport and relationship of trust built up over time. This is true in primary and secondary care alike. Many of my patients complain bitterly about the modern 'system'. Waiting times are shorter it is true - but at great emotional cost. Modification of 'choose and book' is essential.
Lawrence Addlestone, Manchester UK

As a consultant orthopaedic surgeon, I entirely endorse Mr John Black's views. When appointed I hoped to develop a service for my local population. The changes he describes are destroying the personal service I expected to provide. Now I can only do that in the private sector.
Mr Jai Chitnavis, Cambridge UK

In my opinion the patient should be heard and believed. Because not one of the doctors I went to and begged for help believed me I have lost everything - health, career, lifestyle, family, reputation - everything. Speed and choice {my choice!K would have meant I could have accessed some help before I lost it all. I even offered to pay.
Georgina Lynn, York, England

The so-called choice offered is totally spurious. I had a minor operation last year and, if offered a free choice, naturally, I would have chosen to have the same clinician the whole way through. This was not offered. (Indeed, if offered a completely free choice I would have chosen not to have two local hospitals closed down). I saw a different person at every stage of the procedure, and every time I had to go through my case from the beginning as the staff appeared too busy to have read the case-notes. As for the "speed" of care, if I was the responsibility of one person, I imagine I would have had my case progressed rather more rapidly. Being no-one's responsibility but my own meant _I_ had to get pushy to have anything done. "Choice" is spun as empowering, is actually de-humanising.
Kevin, Ramsbottom

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