Our public hospitals in New Zealand are based on – and inherit their underpinning culture from – the British Public Hospital system. They, in turn, grew from the charity hospitals of the 19th century. Then – as is again becoming the case today – people of any means paid for medical care. Those who couldn’t afford a doctor and private nursing – if they couldn’t get better on their own – were stuck with the charity hospital and what treatment the doctors and medical staff thought most appropriate. Patients had no voice – no say in their treatment, and no right to any respect. They were simply collections of symptoms to be given treatment – useful, perhaps, as examples for students, but of no particular value.
Meanwhile, in the private system then as now, patients who could pay for their own treatment received medical advice on which to base their own decisions, and they were treated as clients rather than subjects.
My informant was a GP – he believed that the system wouldn’t change until GPs made part of the decisionmaking care team in the hospital system, as advocates and lead medical advisers for their own clients. Instead, as soon as a GP’s client becomes a hospital patient, the GP is left out of the consulting circle. He or she is sent a copy of any decisions after a hospital medical practitioner has made them, but isn’t part of the care team.
We’ve just paid $400 for our Mum to have a private consultation to receive the information we need for decisionmaking, since she was discharged from hospital without any explanation, information, or care plan. The consultation has not made any difference to medical management; there is no new treatment plan. But we’ve been listened to; we’ve had the opportunity to have questions answered; we’ve had matters explained so that Mum can make her own decisions about how to live from now on. It was $400 well spent.
Ironically, the specialist we consulted is the head of the public hospital team. If he made sure his people did their jobs in the public system as well as he does his job in the private system, we’d have been better off. He, however, would have been $400 worse off. And that’s just one patient. With that incentive structure, what are the likely results?