Unfinished sympathy

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 Maxine Vaccine considers the motives of politicians, clinicians and the pharmaceutical industry and concludes that no matter what direction you approach it from, health is never a simple issue.

My last blog, ‘Life in the balance’, provoked some interesting feedback. I had argued that the current government’s application of free-market principles to the NHS would encourage those doctors who saw what they do primarily as a business rather than as a service. An industry expert commented that a series of health policies over the past two decades, from GP fundholding to QOF indicators, have promoted the same mentality.

This of course is true. Not only are New Labour’s fingerprints all over the current phase of NHS reforms, but the medical profession has never been unified in its perspective on the relationship between health and financial priorities. Different doctors have different attitudes – or have various attitudes in different proportions. Where important decisions are concerned, most of us have mixed motives.

However, it’s rather in the nature of blogs, Twitter feeds, press releases and Parliamentary statements that we pretend otherwise. “Only one thing matters to me” is the opening clause (explicit or implicit) of almost any public statement. “I’m torn” would be bad business, bad politics and bad bedside manner… but it would, almost every time, be the truth.

So let’s be clear that when doctors say “We are motivated only by clinical priorities” it is not necessarily the pure truth. They are motivated to succeed at a professional and business level, and that may extend to practice finances. When the BMA decided to oppose the Heath and Social Care Bill it was not only on clinical grounds, but because the business proposition did not appeal despite its lucrative potential. Maslow’s ‘hierarchy of needs’ is a relevant concept here: the fear of losing control may override the desire to increase your income.

And when politicians say “Our priority is only to improve services” that is not necessarily the pure truth either. Most comment on the NHS reforms has focused on whether the Government is right to believe the new system will deliver better patient outcomes. But is that the only issue? Politicians are not doctors, and – as recent events have proved – they don’t even want to listen to doctors. It’s not cynical to see NHS reform in terms of wider political priorities for society and the economy: that is precisely how politicians see it.

There’s no doubt that Andrew Lansley would like to see patient outcomes improve. But his sense of what can achieve that does not come from expert medical opinion: it comes from the political ideology that assumed privatisation would make the rail service cheaper, safer and more reliable. At least as important, from his viewpoint as health secretary, is the priority of breaking down the national and public sector employment basis of health workers, so that local employers can set their own terms and conditions.

As for the pharma industry – well, it depends on who you talk to. Your CEO will tell you (and the media) that everything your company does is driven by a passionate commitment to making a difference for patients. The public largely believe that everything your company does is driven by the need to make a difference for shareholders. The truth is that even a humble field representative is motivated by a complex blend of factors: short-term targets, longer-term business growth, customer relationships, clinical success, public reputation and the need to laugh once in a while.

Like mixing a drink, medical sales is all about finding the right balance – and not losing your own.

Maxine’s views are not necessarily those of Pharmaceutical Field.