Make no mistake, I am feeling guilty too. That is part of the motivation for this website. I wanted to vote against the new 2004 contract but i realised the tide was against me and that the profession as a whole wanted it. In order to keep us united a number of us voted for the new contract against our better judgement. All praise to Iona Heath for her longer term judgement and rationality. As the devolved Health services collapse (N Ireland, Wales, Scotland ) hers would be a welcome voice in the reconstruction and zero based budgeting that will now be needed.. It is sad, but until we ration health overtly – it’s going to get worse.
The former RCGP president tackles the health secretary and tells Caroline Price a rational approach is needed to reverse the tide of overmedicalisation
Fresh from a trip to Australia, Dr Iona Heath radiates warmth and enthusiasm.
The former RCGP president and renowned writer, who is a champion of a ‘less is more’ approach to medicine, is in great demand to speak at international scientific conferences around the world about overmedicalisation of healthcare.
Although she is now retired from her north London practice, it is easy to hear why Dr Heath is still so respected in the profession. As she sits down with Pulse she talks compellingly of the challenges for general practice in resisting pressure to overtreat and her distaste for the increasing number of interventions GPs are being asked to make in healthy people.
And her movement is gaining traction, with NICE recently releasing its multimorbidity guideline advising a more rational approach to prescribing in those with multiple conditions. But she still has a mountain to climb if she is to persuade politicians, desperate for votes, that medicine and healthcare have their limits.
Overmedicalisation has been partly blamed on increased guidelines and the ‘codification’ of general practice. Has the profession lost its way?
Yes. I think the QOF was done with the best of intentions, but if you define quality in terms of a checklist and try to base all practice on guidelines, then effectively you stop the doctor thinking about the individual patient.
There are all sorts of things that make people ill other than biomedical disease. If doctors stop thinking and just follow guidelines, the chance of making the individual feel seen and heard is reduced dramatically, leading to overtreatment, overdiagnosis and overmedicalisation.
We also seem to have raised a generation of doctors who are afraid of deviating from guidelines and see them as the legal standard of good practice. Young doctors seem to overestimate the rate of complaints and written litigation (although I know it’s going up) because we’re not doing enough to highlight the extent of uncertainty within medical practice. It is impossible get it right all the time. It’s an issue of judgement, every single moment of every day.
Where have guidelines specifically gone wrong?
They’re based on evidence derived from the past. If you’re following guidelines, you are not actually at the cutting edge of research evidence. Take the HbA1c threshold; we now know it was set too low and probably caused significant harm by precipitating hypoglycaemia and falls, particularly in older people…….
…Jeremy Hunt has such bizarre ideas. I don’t think he’s a stupid man but he’s made no attempt to understand the nature of healthcare, and at the same time he’s alienated a whole generation of doctors. He has a fiduciary responsibility to NHS staff to support their morale, to look after them, but I think he behaves in exactly the opposite way. I don’t see how that’s forgivable.
Was the 2004 GP contract a mistake?
Yes, I’ve always thought so. I voted against it and I would do so again – [because of the introduction of pay for performance] but also I think it was a tragedy for the profession that we lost control of out of hours. Nobody can work 24 hours a day, seven days a week, but we lost responsibility for how that was organised, and a lot of people stopped participating because there was absolutely no continuity of care.