Martyn McLaughlin: Patients are not burdens on the NHS, whatever their class

The problem of underreporting is more of a threat to the nation's health than overdiagnosing. Picture: Greg Macvean

The price we pay for becoming healthier as a society is a heightened angst for our wellbeing. What was once quaintly referred to as tiredness is seized upon as the first signs of Seasonal Affective Disorder, while innocuous hobbies are presented as proof of Asperger’s Syndrome.

A few weeks back, during a rare visit to my GP’s surgery, I overheard a patient who had called in to the reception asking for an appointment. A plump and ruddy wee chap, the sort who might find himself mistaken for a ripe strawberry at this time of year, he was the picture of health, and evidently determined to keep it that way.

He was, he explained, a keen golfer whose passion had been curbed by the delayed Scottish spring. But with the sun now kissing the fairways, he wanted to know how many rounds it would be safe to play a week without inflaming an old rotator cuff injury. The receptionist, to her eternal credit, kept a straight face before sending him on his way, dispensing little more than common sense.

A general practitioner friend once joked that he and his peers should be members of the Campaign for Real Ailments. The so-called “worried well”, he said, were one of the greatest strains facing the NHS; patients with no significant medical history and healthy lifestyles, who convince themselves that a common cold was a harbinger of some life-limiting condition. “We see them as patients, they see themselves as consumers,” he bemoaned.

The golfer, for sure, is not alone. At the weekend, he and the rest of Scotland’s middle-class were upbraided by one of the country’s most senior health officials. In an interview, Professor Jason Leitch, the Scottish Government’s national clinical director for healthcare quality and strategy, accused this well-heeled and entitled demographic of being partly to blame for the woes of the NHS.

“The common headline is that of an ageing demographic – that is true but it accounts for about 2 per cent of the increased money we have to spend,” Mr Leitch explained. “But there is another 2 per cent and that is the demand of the middle class: educated, middle-aged people who have grown up with a health service where access is instant and there is never any question of not getting care.”

Hypochondriasis is by no means a newly identified scourge. In the opening of his seminal comic novel, Three Men in a Boat, Jerome K Jerome’s narrator pores over a compendium of ailments, bemoaning how he seems to suffer from every malady other than housemaid’s knee. “I felt rather hurt about this at first,” he reflects. “It seemed somehow to be a sort of slight.”

This irrational anxiety has come into sharp focus given the travails of our wonderful health service. With resources squeezed, it has been reluctant to properly engage with the issue. There is no consensus for how to deal with those who medicalise every part of their life. Some GPs, like my friend, favour a stern approach. Others seek to reassure their patients by sending them for tests to disprove their fears. One approach seems to be reckless, the othjer inefficient. Neither addresses the underlying cause of the anxiety.

The most obvious way to do that is to nurture relationships with patients and building continuity of care, but demands on time render that an aspiration at best. The number of consultations has shot up by nearly 600,000 since 2008-9, thanks in part to the proliferation of self-diagnosing health apps and private screening firms which are only too happy to profit from apprehension before passing the burden back to, yes, the NHS.

Lasting change will only emerge via substantive research. The only considerable body of work to date has been compiled by the Self Care Forum. It claims some 57 million consultations a year for minor ailments cost the NHS £2bn. Harrowing figures, for sure, but it is worth bearing in mind that the forum’s board members include the chief executive of the Proprietary Association of Great Britain, the trade body for manufacturers of over-the-counter medicines.

Given the vested interests at play and paucity of any other research, it would be illuminating to see the workings behind Mr Leitch’s sums. That, at least, would give us an idea of the scale of the problem. Whatever the solution, there is a balance to be struck – shifting demographics and Scotland’s growing population are crucial factors – and what is paramount is ensuring genuinely concerned patients are not dissuaded from seeking expert advice.

What might seem like a minor complaint could be a symptom of an altogether more serious condition. Advocating a culture where patients come to regard themselves as a burden is in no-one’s interest. That may not be the intention of Mr Leitch’s intervention, though it could easily be misconstrued as such, deliberately so by those with a political interest in dismantling the NHS altogether.

Scotland’s health is improving, but with life expectancy still the lowest of any part of the UK, we can ill afford to turn people away at a time when over-diagnosis is weighed against under-reporting. Take the Scottish Bowel Screening Programme, which has seen 1.4 million people come forward to be screened over the past decade; an impressive return, yet it is worth remembering that invitations were sent to 2.2 million Scots in all.

The imagined disorders of the “worried well” are a problem, but it is the unworried unwell we should be engaging with.