Doctors receive an expensive training, much of it paid for by the taxpayer. On qualification, GPs in the National Health Service are not only paid so much per head for their thousands of patients, but their practice costs are also met partly by the taxpayer. And cheap loans are available to them for premises.
Few GPs are available at all hours nowadays. Most work in a group practice and calls at awkward hours are dealt with on a rota system. In recent years, moreover, it has become usual for patients who want attention outside surgery hours to be referred to one of the locums provided by a commercial deputising service.
Most of us in our work have to cope with rude or difficult people sometimes. GPs are not exempt. But for every bolshie or batty patient there are likely to be several appreciative and pleasant ones. And although most GPs can be a pleasure to deal with, there are a few of them, too, who can be incompetent, ignorant, incoherent or in need of a shrink. Which of us has not encountered the occasional GP who is unfit for his job?
The problem is that the few who are unfit are encouraged to continue that way by the knowledge that there is little their patients can usefully do about it, except move to a different neighbourhood. If a complaint to a rogue GP about his behaviour only makes him worse, what can you do about it? By the time you've recovered from your illness, caught up with your work and found out that the body to whom you are supposed to complain is the Family Health Services Authority, more than 13 weeks may have elapsed - in which case you will be told that it's too late to make a complaint. The Health Ombudsman is likely to agree with that.
A parent who rings his GP at midnight to demand a visit to his child, who subsequently turns out not to be ill, may prefer to risk wasting the GP's time rather than the health of his child.
Anyway, how many GPs visit patients at all? Consider the following case of a man, a patient in a trendy London NHS practice, who developed an acute infection.
8am: 'A doctor will phone back or call in.'
3pm: 'Oh, hasn't anyone contacted you? A message was left on the board and has been taken. The way to get a reply is to ring back at emergency service time, at about 7pm.'
7pm: 'No doctor is available at the
8pm: 'I'm Dr X. What is it?'
'Severe painful and disabling symptoms, including swollen neck glands, but not inflammation of the throat.'
'You have influenza, Definitely. Take an aspirin. Visit the surgery in the morning.'
'I'm too ill to visit the surgery. And it seems improbable that I shall have recovered sufficiently in the morning to make it to the surgery. I don't have the usual influenza symptoms and I have swellings at the back of my neck.'
'Swollen glands are usual in influenza. You have flu.'
Four days later the man had recovered sufficiently to get to the surgery, with help, though he nearly lost consciousness twice on the way. He saw a colleague of Dr X, who referred him to hospital. He was admitted as an in-patient for several days. The infection was not influenza.
There is a sequel. The man wrote a polite protest to Dr X. Then, two years later, he consulted him, being very ill again, this time with pleurisy, bronchitis and bronchial pneumonia. Dr X demanded to know the man's qualifications for his job. Apparently he had been simmering with resentment for two years and he saw his patient's illness as an opportunity for vengeance. Only after that did he give a brusque examination and a prescription. He did not at any time visit the patient.
Perhaps there was an age of innocence when many patients looked up to GPs as if they were God. Now more patients are educated, and some are sceptical. Most GPs appreciate the easier communication and more realistic expectations that this has brought about. But some resent being demoted from their pedestals.
GPs in the NHS not only have the right to refuse patients, they have the right to opt out. They can change to a different occupation, set up in private practice, or emigrate. And some do. Others, like most of us, get on with their jobs to the best of their abilities, accept that most occupations involve dealing with some people who are difficult and thank their lucky stars that they aren't on the dole. My own GP is probably much more typical than the monsters or the moaners, being conscientious, courteous and, to the best of my knowledge, competent. Phew.