As you won’t (but most regular readers do) I’m also from the UK. What Pollyanna says is true of PHP; at hospitals, the medical staff are employed either by the hospital or sometimes by the health board (sometimes a county, sometimes a city, sometimes a geographical area that covers several counties).

As I’ve said a number of times (I think) I’ve known PHPs who were known for late running surguries, not because they started late but because they gave patients presenting the time they needed rather 6 minutes because that’s what we’ve been told to give them.

I would have to disagree, to some extent, with the problem being to do with paying for care. Somehow, somewhere, care has to be paid for – otherwise doctors won’t earn a salary. Whether it’s the government that pays or insurance companies or individuals, doctors will still need a certain number of registered patients in order to keep the money rolling, or trickling, in.

Over here (in the UK) the doctors are NOT employed by the NHS, as people tend to assume. They are self-employed and contracted to the NHS. The NHS pays x amount to a surgery per number of patients registered, and then top-up amounts for patients with R.A., patients with diabetes, patients who are being helped to stop smoking etc. etc.

Now here’s the rub – it’s up the surgery to say, ‘We have 2,000 patients registered, many are elderly or have chronic disease, so we need to split our amount between ten doctors to cover the workload’ OR ‘We have 2,000 patients registered, many are elderly or have chronic disease, but all the partners in the surgery want a decent living wage, and to do that we can only afford to employ seven doctors.’

So even though there’s no payment involved in the US sense, the patient still suffers from the usual six-minute appointment slots, over-pressured doctors etc.

Sorry this comment is so long! It’s probably gone over the character limit and won’t get through. Oh well…

Tricks that good PHPs I’ve known use include not using their computer during a consult, and actively arranging their surgury (that’s the room, not the opening hours) so that their desk is beside them, not as a barrier between them and the patient.

Davis Liu, MD
Author of Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America’s Healthcare System
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