A strike of young physicians in Britain exposes faultlines in the country's National Health Service. But the relationship between the British and their universal health program is complicated.
The British National Health Service, NHS, like its population. is not aging well. That British young doctors are going on strike Dec. 1 is a surprise given the rather liberal attitude of the western world. The NHS created by Welsh left-wing Minister of Health Aneurin Bevan started well enough in 1948 after which Bevan became Minister of Labour. He resigned from the British government in protest because, although World War II was over, the British military was still costing the country a lot of money as was dental care and spectacles.
Soldiers coming back from the war had been used to healthcare from faceless physicians not necessarily ones they had seen the day before. They had lost the need to have a private physician. They were ready to receive medical services as individual items of service and didn’t see the need to have longitudinal care. The health service was somewhat anonymous now especially since it was almost free. And at this time the British medical institutions were not privately owned such that no money had to be spent to transfer their proprietorship to the government.
I came into my family doctor’s surgery (office) about that time to be tested for my First Aid badge in the Boy Scouts and wondered what was going on because men were moving out the burgundy leather arm chairs and replacing them with workbenches.
What was going on was he was replacing all his seating; he anticipated he would need more benches. He would also need more patience. And from his patients he would need more generosity because when healthcare was essentially free, people tended to abuse the service. The analogy at this time was this: If babysitting and movies were free wouldn’t you go more often, and if a doctor visit didn’t cost you anything why would you stay away?
British patients didn’t. They went from stalwart spunky patients to almost the “worried well.” Except they weren’t all that worried. It was just that it was free. No problem was too fastidious for their concerns or too trivial or too expensive for their attention.
I graduated from Edinburgh Medical School in 1958, 10 years after the NHS began. Graduating medical students felt it was likely that since a doctor could get a minimum 10-year pension from the government some older doctors would retire. Who would want to work for the government? Who indeed? Answer: all of them! Not only that, but the UK cancelled its Selective Service and not only were graduating doctors no longer finding a two-year gap to evaluate their careers but they were confronting a lot of ex-military doctors entering civilian medical life; medical jobs were not plentiful and the remnant of the British Empire called.
What has this to do with young doctors threatening to strike? Well, it reflects the curious up-and-down nature of how British patients and their physicians feel about their relationship. It has been said that British doctors hate their patients and American patients hate their doctors. Neither is true, yet I have heard both said. Usually in America members of a group will point out how much they care for their individual personal doctor then they will often say they feel the American Health machine is broken.
I think that in the United Kingdom doctors and patients struggle to be fair to each other and that physicians do a better job of working with their patients than their patients do them. Over the decades I’ve had former medical school friends tell me how selfish and unreasonable patients have been. A GP, dreading how many house calls he does on a busy day, once told me, “Never take on a patient who has a telephone but not a car!”
It can be a difficult relationship. I’ve heard of Government officials begging patients not to be so obnoxious to their doctors but I’ve had GPs admit that their house call load is so heavy, that all they have time to do is listen to a chest so they go in with just a stethoscope and do not take in a sphygmomanometer.
Those relationships improve and deteriorate over the seasons. I remember a consultant in internal medicine in the Scottish County of Fife (sometimes called the Kingdom of Fife, just north of Edinburgh’s Midlothian). He told me he always knew when he was in the administration side of the hospital because, in contrast to the physician’s side, the administration side always had a thick expensive carpet.
Photography by the author
The Andersons, who live in San Diego, are the resident travel & cruise columnists for Physician's Money Digest. Nancy is a former nursing educator, Eric a retired MD. The one-time president of the New Hampshire Academy of Family Physicians, Eric is the only physician in the Society of American Travel Writers. He has also written five books, the last called The Man Who Cried Orange: Stories from a Doctor's Life.