Liam Farrell: Three cheers for no gain from pain

One of the great strengths of the NHS is that GPs have little financial interest in our patients.

Apart from holding them upside down and shaking them for points (maybe leave 'em hanging for a while 'til they're nice and gamey), we can be dispassionate and objective.

This contrasts with many other health systems, where patients are clients to be mercilessly milked and pumped.

When I was a lad, working in another jurisdiction, a senior colleague at my practice called me aside.

'I'm off for the day, I have an important meeting, so you are seeing Mrs Magee today. At all costs keep her alive,' he told me, brushing a fleck of dust from his expensive suit. 'She hasn't paid her bill yet.'

'Take the money off them,' advised another, expectorating loudly into a golden spittoon (private practice pays very well), 'while the tears are in their eyes.'

There is often a financial incentive to over-investigate and over-treat. Imagine if you are working in a private hospital when a kid comes in with abdominal pain. You aren't sure; is it appendicitis? Should you operate or observe overnight? It can be a marginal decision. Then consider the difference in income to the hospital (which pays your wages) of theatre time, nursing time, surgical and anaesthetic fees and so on, compared with just watching a kid lying in bed overnight; would that be likely to influence your decision? Just a tad, maybe, if you're human.

Conversely, there can be a drive to under-investigate and under-treat. A few years ago, a delegation of Russian doctors visited my health centre (why the local health board sent them to me, I don't know - perhaps I looked like a kulak). They sat in on each consultation, and after the mandatory prescription, would ask, 'Who actually pays for this?'

'Indirectly,' I said, not having thought about this much before, 'we all do. The health service is funded by government, which raises funds by taxation.'

They'd then look at each other, shrug their shoulders, and have a brief but animated discussion in Russian (probably on the lines of 'there's bugger all wrong with any of these people' or 'not MORE bloody antibiotics').

Their next question was, 'Who is the high doctor?'

At least that was easier to answer.

'We all are,' I replied.

Dr Farrell is a GP from County Armagh. Email him at

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