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Anatomy
of the modern patient
Scientific medicine has never
been better. But the more it achieves,
the less it seems to satisfy. Modern
patients are said to be doing better
but feeling worse. What distinguishes
them from those of 50 years ago?
Better education The number
of undergraduates increased by more
than 80 per cent between 1970-71
and 1996-97. This includes a four-fold
rise in the number of women students.
Over the same period there was a
12 fold rise in women enrolling
in postgraduate courses.
The consumer movement So-called
patient power is a by-product of
the consumer movement which began
in 1963 with the formation of the
National Consumer Council, forerunner
of the Consumers Association. For
years, patients’ rights were
not so well articulated as women’s
rights, democratic rights, or black
civil rights, but now they are assuming
a sharper definition.
Access to information Denying
patients information used to be
official NHS policy. Hospital case
notes were stamped ‘Not to
be seen by the patient’. Now
the Department of Health is inviting
the modern patient to join the information
revolution.
Great expectations The NHS
was a triumph for the social ideal
that medical care should be administered
according to medical need rather
than the ability to pay. It was
heralded as the envy of the world
and initially, unlike today, public
expectation knew no bounds.
The NHS-doctor relationship
An increasing worry since the Health
Service reforms in the late 1980s.
Recent reports that doctors have
been telling patients that ‘no
more can be done’, when the
NHS will not pay for certain treatments,
highlight the scale of the problem.
The elderly may be particularly
vulnerable.
The NHS-patient relationship
The early success of the NHS created
a unique bond between government
and patient. No other state-funded
institution has been regarded with
such affection as the health service.
This was summed up in 1988 by Dr
David Owen, a medical practitioner
and former Labour Health Minister,
in his book Our NHS.
He wrote: ‘The NHS belongs
to us all because it is personal
to us all. Most of us have cause
to be grateful to it at some time
in our lives. A distinctive feature
of the British health care system
is the extensive and personal nature
of the care available… there
are no essential services which
are not available free at the point
of demand.’
Recalling his son’s successful
treatment for childhood leukaemia,
he said: ‘At no time during
the treatment, which cost something
like £47,000, did we ever
have any financial anxiety to add
to all the other anxieties that
we and many more families undergo
in these circumstances.’
He was speaking for millions, but
the worry of the availability of
treatment has severely damaged the
NHS-patient relationship –
and with it the doctor-patient relationship.
Rationing The first NHS
generation was brought up on ration
books, but could not have foreseen
the modern era of ‘postcode
prescribing’. All over Britain,
for a variety of illnesses, people
are not getting medicines that could
help them. Some Health Authorities
make new and expensive treatments
available, while others discourage
or even prohibit their use, often
on cost grounds.
Complementary medicine The
new pick’n’mix medical
culture is said to represent a flight
from science. More than one in five
people in the UK have used complementary
medicine in the past year, compared
with one in ten six years ago, according
to an independent ICM poll. But
research suggests that this is not
because of any rejection of orthodox
medicine. Patients want choice.
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