I don’t know how you make a living, doc

One of my patients often tells me that she used to say to my predecessor, “I don’t know how you make a living, doc, cause I’m never sick.”

Things changed when she was diagnosed with a TIA and we found an irregular heartbeat. She now often expresses her gratitude for the care available, close to home.

Like so often in life, we only value something when we perceive a need for it. Emeritus Professor Max Kamien recently reminded me of this when he quoted James Dickinson in a comment on this blog post.

Dickinson, a professor in family medicine, used to work in the Federal Department of Health. He said that health policy is devised by young, healthy, non-medical advisers who do not have a need for a personal GP and instead use impersonal walk-in practices.

They often regard these experiences as being substandard medical practice. As a result, he said, they do not understand the multiple tasks required for good quality general practice and do not perceive its relevance.

This could perhaps explain the incomprehensible decisions that often come out of the department, such as defunding ECGs in general practice (a test which was crucial in the diagnosis and management of my patient).

I sometimes wonder, is it worthwhile spending more time and effort on educating policy-makers in the department of health?

6 thoughts on “I don’t know how you make a living, doc

  • Certainly, Edwin. You’ve hit the nail on the head. In Africa, where I spent my early days in medical practice, I found that policy makers in the department of health were mainly nurses. They had some bias against the doctors. So, in addition to being young and healthy, the backgrounds of the health bureaucrats also determine health policies, some of which are profoundly anti-qualitative care of the patients.


  • The concept of the folk making health policy being so inexperienced in issues related to chronic disease is blood curdling. They should definitely be educated, and fast.


  • Great reference to Max’ previous post!
    One of the convincing arguments is that GPs deliver healthcare cheaper than when it’s done by hospitals and specialists.
    Another one we don’t often hear is the GPs contribution to Quality of Life. I’ve been pondering about studies in relation to this. In my mind it should be measurable somehow that a holistic continuity of care model is superior in parameters relating to Quality of Life. I just did a quick search and found an attempt to demonstrate this. (https://bmjopen.bmj.com/content/10/1/e030110). The setup with nurses and pharmacists as part of the regular team appears a bit clunky in this study. I’m sure this collaboration could be much better and is better on a day to day basis already.
    Our system could be better facilitated when a pharmacist or primary care nurse is indicated (rather than through GP management plans and Medication reviews).
    It would be great one day to see scientific evidence which confirms GPs suspicion of their highly effective and efficient care systems. The study I referred to is not easy to set up, but I think it’s an essential element to tow the sceptic but too healthy bureaucrat/ pollies over the line.
    In spite of this: I do wish the pollies/ bureaucracy to keep healthy though and help primary care to get healthier for the sake of their constituency and budgets!
    Yes the ECG decision is a massive kick under the belt.


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