Why do I have to prove I'm value for money?

As a newly qualified salaried GP, I felt greatly encouraged by your Valuing General Practice articles and campaign.

In that context, an incident at work this week might be of interest to readers.

'How can I help you?' I chirped as my patient walked in.

'Give me some of your money!' came the alarming reply.

Was it a stick-up? Highway robbery? Was I to be mugged in my own consulting room?

Thankfully no; it was just Bill, with another of his rather samey witticisms.

Suppressing my flickering irritation, we got down to the business of sorting out his badly controlled diabetes (he just can't remember to take the tablets) discussing his smoking (don't even ask) and trying to address his quivering beer belly (what can I say).

There is sometimes a grumbling heard about an erosion of respect for doctors in the UK today.

In many ways, it has not really bothered me much. Greater perspicuity, the demise of paternalism and increased patient autonomy always struck me as improvements in the doctor-patient relationship.

But increasingly I seem to be coming up against a rather darker creature lurking in my patients' psyche - resentment; the sentiment that we are paid too much for what we do.

Several of my colleagues have also been in the position of explaining their salaries at dinner parties, family gatherings or patient inquisitions. Insides squirming, I have found myself uttering such phrases as '10 years of intensive training' and 'high levels of responsibility'.

Does Bill's heart not really matter as much as making companies money or suing massive corporations? Should I be replaced by a computer that can tick the boxes twice as quickly for a fraction of the price? Or perhaps we've lost sight of what we value as a society. Is money the only thing that matters?

In some ways, it is inevitable GPs are in the public's line of fire. Which other public employees spend 80 per cent of their time seeing the very people to whom, ultimately, we are accountable?

And yet so many of them seem to take their opinions from the tabloids rather than their lowly GP trying to dodge bullets from the PCT, MPs and media.

I am not naive enough to suggest that money is not important but perhaps there would be less resentment if the headlines featured something other than how much we are paid - such as that I'm trying, in a very tame and non-newsworthy way, to save Bill's life?

Money runs the show. But should it? Would we, as doctors, still come in if they slashed our wage? Not that I'm saying we should, but it would be an interesting test of our motivations. Would our patients have a better opinion of their doctor if they were paid the same as a librarian, seen simply as a keeper of and access point to information and services?

I don't want my patients to resent my salary; I think I earn it and it'd be nice to think they felt the same. But I may be facing a losing battle until those seeking to chip away at what makes general practice special see value in compassion, communication and holistic career.

Happily for Bill, he went away content in the knowledge that his GP's stopped smoking box continues to wink away. The new BP tablets also mean a legitimate reason to pop back in a week or two, for another round of harmless banter.

Dr Caroline Swinney, north London.

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