Welcome to the Nagging Health Service
Some health fanatics want everyone from GPs to hospital porters to lecture to us about our lifestyles.
‘Make every contact count’ is the big idea. Whenever a health worker – any health worker – meets a patient, they should be ready with advice on how to change that patient’s lifestyle. This notion is crystallised in a new proposal to discuss patients’ habits every time they see their doctor. In other words, it’s ‘make every contact a nag’.
The proposal, put forward by the National Health Service’s Future Forum, would see patients asked about their eating, smoking and drinking habits whenever they see a health professional – even when the patient is suffering from an unrelated illness. Dr Steve Field, the Lib-Con coalition’s so-called NHS troubleshooter and chair of the NHS Future Forum, told the Guardian: ‘In future if you come for your flu vaccine at a GP’s surgery or pharmacy, the health professional should give you your injection but also use the opportunity to talk to you about your diet, smoking, alcohol intake and how much exercise you’re taking, discuss any anxieties you may have about these, and offer advice and support. Similarly, a podiatrist who’s looking after the feet of a diabetic patient has an absolute responsibility to talk to the patient about their smoking, because smoking makes diabetes worse and means the patient is more likely to have a foot amputated.’
Now, it is obviously entirely sensible to talk to someone about their personal habits when those habits have a direct connection to a health problem and during a consultation with the person in charge of dealing with that problem. So, if I have breathing problems, it would seem sensible for my doctor or hospital consultant to find out if I smoke. If I have a gastric ulcer, then my eating or drinking habits might be making that worse.
However, there is nothing worse than going to the doctor only to be lectured about something irrelevant to your condition. There is every chance that this policy will simply put people off visiting their doctors. The chair of the Royal College of General Practitioners, Dr Clare Gerada, made exactly this point to the Guardian: ‘Young men pluck up the courage to go and see their GP, maybe about a sexually transmitted infection, and would not want to be lectured by a middle-aged woman like me. So we have to be careful that we don’t impose our agenda on to the patients and don’t inadvertently frighten patients who are coming in to see the doctor and who fear that they might be preached at.’
Turning the NHS into the Nagging Health Service will only compound problems. It’s bad enough when your doctor bends your ear about your smoking or drinking. But some would like to take the nagging culture much further. Writing for the Guardian’s Public Leaders Network last year, Dr Wendy Richardson – director of public health for Hull – discussed how the NHS in Yorkshire and Humberside is getting everyone involved: ‘Instead of relying solely on medically trained staff or public-health professionals to promote healthier lifestyles, we need to recognise the huge potential of the wider NHS workforce. From hospital porter to GP receptionist, every day frontline staff have millions of interactions with people that could make a positive difference to their health. Yet all too often, through lack of awareness or confidence in addressing what are often sensitive issues, they miss these opportunities.’
Who would find this process more cringe-inducing? The patient, for whom every contact with the NHS is now an opportunity to be lectured about his or her personal pleasures, or the porter or receptionist given a script to lecture every patient with? If any idea could be more exquisitely designed to poison the relationship between NHS staff and its users/customers/clients, it is this ubiquitous evangelising about ‘lifestyle behaviour change’.
But while the criticisms of the new policy made by Gerada and others are correct, there is another more fundamental point: what I choose to drink, smoke, eat and so on is no business of health workers. In fact, it reverses the proper relationship between doctor and patient.
When people with power over us – like the gatekeepers of healthcare: family doctors – start quizzing us or lecturing us, it has an entirely different character to a friend or workmate gently suggesting we should ease off on the booze or fags. When a doctor starts dishing out stern advice, there is the implication of a refusal to help if we don’t play along. That inference is not an unreasonable one to make; in recent years, treatment has been refused more and more to those who do not live in the prescribed manner.
Yet as the microbiologist Rene Dubos noted in the 1960s: ‘In the words of a wise physician, it is part of the doctor’s function to make it possible for his patients to go on doing the pleasant things that are bad for them – smoking too much, eating and drinking too much – without killing themselves any sooner than is necessary.’ Doctors should apply medical knowledge so that I can be free to live as I see fit, not use medical authority – at the bidding of their political masters – to browbeat me into adopting a lifestyle that receives the official seal of approval.
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