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It's a sick system that rewards no treatment.

I had just given my patient a prescription for her sore throat when she said she had a personal question to ask me ...

"Do doctors lose money if they sign people off from work?"

It appears that her mum, who lives on the other side of the country, had suffered a painful attack of arthritis.

And although she found it difficult to get about, the poor lady's doctor wouldn't sign her off work for more than a few days at a time.

I'm glad to say that I was able to put Mary's mind at rest - no doctor's pay is linked to the number of sick lines he writes.

But the question set me thinking. Not so long ago, no-one would have doubted their doctor's advice was based on anything other than being helpful.

If the doctor said a test wasn't necessary or an operation wouldn't help, then that was it. End of story.

But since 1990, all that has changed. Fund-holding GPs now have their own budgets for tests, hospital admissions and operations.

If they save money, that saving can be spent on a pet project. However, if money is extra-short, they must choose between the needs of one patient or another.

As one Derbyshire doctor put it when announcing that he was quitting fund-holding: "Patients expect me to do what is in their best interests. But what I was being asked to do was to keep one eye on the bank account."

As long as GPs are being asked to ration health care, every decision will be open to suspicion.

The vast majority of GPs still put patients' interests first, no matter the cost.

But while we have a system that rewards doctors for denying treatment, there will still be that small element of doubt.

This government has a lot to answer for!


Q I have a pain in my chest and my doctor said it is due to Bornholm's Disease. What is this and is it serious?

A You have become infected with a virus that causes the joint between your ribs and breast bone to become inflamed and sore. It will get better without treatment but painkillers will help the symptoms.

Q I am on tablets for depression and I have read that some foods should be avoided. Which are they?

A Some anti-depressants called Mono Amine Oxidase inhibitors react violently with foods like cheese, Marmite or red wine containing the chemical Tyramine and none should be taken with alcohol.
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Title Annotation:Features
Author:McKee, Ian
Publication:Daily Record (Glasgow, Scotland)
Date:Feb 21, 1997
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