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Thursday, 9 August 2007

Teacher Student phenomena

When we were in school, we did a lot of things because teacher said so. Against our liking, but we did it. Like i mentioned before, a change of behaviour, does not necessary stem from a change of attitude in the heart.

When i was young, i did a lot of thing because my mum said so. Just to satisfy her, so she's off my back.

At times when i was naughty, my mum would send me on my knees, and i could only get up after i have said sorry. Sometimes i was stiff necked, and i could kneel there for an hour before i said sorry. Sometimes i wanted to play with my friends, so within a minute, i said sorry and i was off the hook. The whole aim of that exercise was that my mum wanted me to repent. Sometimes i was really sorry, but sometimes i wasn't.

As i grew older, i started to have my own opinion. At work, in church, with friends and with parents. Still, sometimes i voiced my opinion and ended up looking weird, either due to my foolishness (sometimes) or my intelligence (less than sometimes). Sometimes i decided to go along with the crowd in order to get along. Just to satisfy them, not because i agree with them deep in my heart. This happen more so at my work place.

After these few days of my meeting with GPs, on the political agenda of Department of Health in the UK to give free healthcare to as many people as possible, with limited budget,hence using cost-effective drugs, i went home last night and reflected on my conversations with them.

Few Gps said : it's really hard for them to switch to a more cost-effective equivalent medication when the patients have been on it already. They see the patients and they face the demand and pressure from the patients. This always makes me wonder who is the patient and who is the doctor here. Personal opinion aside, they gave reasons and justification for their non-evidence, non-national guidance prescribing behaviour, justifying that their behaviour are doing good for their patients.

Well, that's avery selfish, as if only their patients matter to them, not those who belong to other GPs. Their spent on expensive drugs on their beloved patients will compromise the money available in the pot for expensive chemotherapy or other expensvive procedure for someone else.

So their perception of providing "the best care" to their patients is at the expense of others access to treatment. Is that caring? Is that selfish?

Then, after all the justification, they said this to me: " We will do it if this is what you want, if this is what the PCT target is "

I think that is so immature. So we are back in school again. A student doing it because the teacher said so. A behaviour that is external. They don't see the philosophy of the FREE charity-like NHS system in UK, and them being a part of this imperfect system, of them pocketing their salary from this imperfect system.

It's like someone who is eating the doughnut and saying the doughnut is not tasty.

They don't understand that we are all in the same boat, we are in this together, providing care for the patients. They don't understand they philosophy of NHS.

It's free for all, and it's about maximising the greatest benefit for the greatest number of patients, most importantly, with a limited budget.

With that in mind, it's about what patients need, rather than what they want. The Gps told me their patient demand E45, and refuse aqueous cream, when they are the same thing, apart from brand. They gave in, they wrote a prescription on E45. Reason: the patient demanded that. That is want, not need.

Being an idealist, i don't like student behaviour. They did it because the higher authority, government in this case said so, and it is in the target.

Another very realistic view is the true human nature: humans do not like to be told what to do.

GPs want to exercise their "clinical autonomy", hence thinking that national guidelines have restricted their expertise. Well, when it comes to first line choice of medication, government has reviewed all the drugs on the market, and came to a choice of effective drug that work just the same, except it's cheaper. What's wrong with that? They told me that national guidelines and government target have made them robot.

Will they ever see it ? i wonder? Or is it just a mixture of caring for their patient, using more expensive medication, at the expense of other expensive treatment for other patients.

All this came after my conversations with Gps. At that moment, when i am face to face with them, i didn't have the heart to say that. Maybe because i don't like conflict and confrontation, maybe because i value the rapport with them ?

I don't know. But i hope, in the future, i will be smarter and accept that teacher student phenomena is needed in this political world, as the graph and figures on the target look good, more than anything.

By the way, Islington GPs come 1st in London, when in comes to using cost-effective choice of statin: simvastatin for cholesterol. The department of health has a league table for all region in the country for percentage of simvastatin compared to other statin.

On retrospect, i have achieved my objectives when i applied for this job: to see the real politics. I saw a lot of those in these 2 years. Maybe it's enough, too much of it is not healthy.

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