IM Beck on (1) appointment system at - 23/7/2005

link to article in The TIMES

.M. Beck quote unquote
I want it all, all the time
I.M. Beck

Last Sunday's KullHadd, a newspaper I read over the net, had a cartoon on the front page (of the net edition, anyway - where it was on the bin-liner edition I don't know) that was sadly symptomatic of the welfare age.

The cartoon referred to an idea that seems to be gaining ground, namely that doctors at the area clinics (are they still called Polyclinics?) should see people by appointment. I wouldn't have thought that this was something that should have raised the ire of KullHadd, though having been a consumer, a year or so ago, of the on demand element of the medical services offered at the Mosta Polyclinic, I see the value of having a medical gentleman on tap, as it were.

The cartoon, referring as it did to this appointment notion, had the citizen who was the protagonist of the piece saying he'd better start thinking to book the undertaker.

This is worrying. The type of person who thinks like this is the type of person who thinks that the whole world owes him or her a living and that everything has to come to a grinding halt to pander to his or her every whim.

I have to assume, this being the 21st century, that the appointment system being cooked up would cater for emergency cases or cases where an appointment would be otherwise impractical. But does this assumption even begin to figure in the thought processes of the type of person I've just described?

No, of course it doesn't.

This is the sort of person who - if the fancy takes him or her - would traipse off to A&E at St Luke's with a common cold and demand to be seen immediately if not sooner and who would bend the ear of his or her MP for hours if kept waiting for longer than one minute.

The cartoon also betrays the thought processes of a certain type of person, the hypochondriac who is convinced that if he isn't seen immediately (preferably for free) by a highly trained professional, his heart will stop, he will get terminal constipation, his hair will fall out and, generally, he will be on a fast train to an early grave.

Stop fussing, why don't you? It's people like you who clog up the health and social services and waste resources. It's people like me, with the taxes I can't avoid paying, who have to fund your foibles.

Healthy disputes

The Ministry of Health has been in the news recently. First, the minister got a nice shiny award for imposing progressive and well thought out restrictions on indoor smoking (boy, it's difficult to type with your tongue in your cheek) eventually prompting people like Revel Barker in a letter last Wednesday to ask how many people have died from emission-related (as opposed to smoking-related) diseases last year.

Then the medicine importers get all nasty with the ministry, demanding payment for the medicines they have supplied to the government. What do these people mean, asking to be paid for the privilege of supplying stuff to the government? After all, when the government wants their money, it waits, doesn't it?

Oh, no, sorry, it doesn't - if you owe income tax, VAT, social security payments or any other tax or impost the jolly old government will seek to relieve of your cash pronto and woe betide you if you can't come up with the readies.

Now the ministry's foot-soldiers, the doctors who actually provide the service that the ministry is there to provide, are getting all het up about their remuneration.

Frankly, this has been a problem waiting to happen for years. The country can't afford to pay all the consultants and assorted other medical experts the sort of money they can earn in the private sector, so a compromise on the English model has been in uneasy use for as long as anyone can remember. In the mornings, the doctors concerned are public servants, in the afternoons and evenings, they are private sector operators.

The tectonic plates that make up this particular market seem to have shifted slightly over the last couple of years, however.

The dreaded Tax Compliance Unit has flexed its muscles and queried, with some degree of eventual success, why not all doctors were paying their full whack of tax. This didn't make the medical profession jump up and down in celebration, understandably, and now the doctors are again starting to jump up and down, again not in celebration but in protest at the fact that one of their number seems to be something special, at least if you look at his pay packet.

The ministry has - rather pertinently - pointed out that the chap concerned (look at Wednesday's editorial if you want names) doesn't have a private practice and his contract has been in place for quite some time now. The doctors' union, on its part, and also with some justification at law, has been pointing out that people who perform work of equal value to their employer are, actually, entitled to remuneration of comparable value.

Whether or not every other consultant does really perform work of equal value as the non-privately practising consultant (who really is a paragon of medical virtues, and I mean this without a trace of sarcasm) is debatable but it is also very debatable whether the real difference in value is reflected at the end of the month.

Who'd be Minister of Health, ay? Oh well, at least he gets to prosecute smokers every so often.

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