Dr. Sarah Myhill is a physician practicing in Wales. She has withdrawn from Great Britian’s National Health Service and gone into private practice. Her thoughts on the matter should inform every American who is a patient, and every physician who is frustrated by the United States government’s overwhelming intrusion on their efforts to treat their patients. ACW
A private medical practitioner – to be or not to be?
“……..particularly the economics of your private practice would be of great interest to our readers” was the brief given to me when asked to write a short practice profile.
It is generally assumed that doctors go into private practice in order to earn lots of money. Fine, if you are an NHS Consultant with a long NHS waiting list which patients can jump courtesy of BUPA. These economics do not apply to the single GP living in rural Wales where, let’s face it, the local people are very careful with their money, trying to compete with the local medical service where consultations are free, prescriptions are free and referrals to the hospital are also free. No, economics is not the reason why I have ended up in private practice. Indeed, I have to say I am very bad at economics – I know I have enough money to give myself a very adequate lifestyle and see my two daughters through university.
I have no savings, no pension plan and no intention to retire because I enjoy my work. For me not to work would be the death knell. This style of medicine suits me. However, I would not advise any young doctor to tread the path I have trod unless they have very good reason. It is fraught with insecurity, lack of support and of course very poor holiday entitlement. Furthermore, other doctors who do not understand my style of practice regularly complain about me to the GMC and although none of these complaints has come to anything, simply answering their numerous queries is tiresome.
The only reason I can see for a General Practice grade doctor to go into private practice is for clinical freedoms. I have worked for 20 years within the NHS in General Practice and increasingly found myself restricted by what I was and was not allowed to do. Having recently spent six months as an Associate Specialist at the Royal Shrewsbury Hospital working with patients with chronic fatigue syndrome, these restrictions have become so great that I am simply unable to practise there. All that one is allowed to do for patients is that which is “evidence based” and that evidence base certainly does not include one’s own years of experience. This means that one ends up serving two masters.
Firstly the PCT who dictate what is and is not allowed and secondly one’s own conscience. Indeed, the first rule for good conduct by the General Medical Council is “To make the care of your patient your first concern”. That is to say doctors should be patients’ advocates, fighting as hard as they possibly can for what they believe is the best treatment for each patient. Instead, many doctors have become what I call “defenders of the faith”. The big problem being that the “faith” is laid down by Big Pharma who manipulate drug trials in order to give favourable outcomes (gosh, when I dictated that originally it came out as incomes! Actually either would do!). As a result of which medicine today no longer follows a logical and independent science base. Indeed, the current system of post graduate medical teaching is akin to mothers learning about nutrition from advertisement hoardings posted by the food industry.
I believe modern Western Medicine has lost touch with patients. What patients actually want is an answer to the question why they have developed their particular problem followed by which nutritional, lifestyle or environmental changing factors need they put in place to allow improvements. In pursuing this object, I have become the Secretary of the British Society for Ecological Medicine, a medical organisation in which we have our own scientific journal, our own bi-annual scientific meetings at the Royal College of General Practitioners as well as running training meetings for GPs and Consultants. All the medicine that we practise has an excellent evidence base, but of course not the mega financial resources to sell this to the health industry in this country.
So my practice of medicine has evolved from an entirely conventional training at the Middlesex Hospital, London qualifying in 1981 to something very different. Now the focus of my practice is on looking for causes of problems with respect to diet, micronutrient status, allergies and lifestyle changes. This approach is highly successful at tackling the majority of medical problems. Indeed, if this package was applied across the board, then the pattern of chronic disease, degeneration and cancer in Western nations would undergo a radical change. (To be continued)