‘These findings suggest that physiotherapists should develop a good understanding of patients’ concerns, and take them into consideration, before delivering their reassurance.
I’m wondering whether the neoliberal “explosion of personal choice” applies to healthcare. Are people really “overwhelmed by their options”? Don’t most people rely on a creaking public health service? Is choice reserved only for the wealthy who can afford private healthcare?
With just a quick look I can see 20+ gymnasiums, 15+ mental health specialists, 2 nutritionists, 3 acupuncturists, gynaecologists, physiotherapists, 4 traditional Chinese medicine practitioners, skin specialists, sports medicine doctors, and Ayurvedic practitioners all within 10 miles of where you live. That doesn't include the millions of health advice websites, IG and Pinterest pages, YouTube channels and consumer health magazines that people are now using.
So, clearly there's a lot more 'consumer' choice than would have been available to our parents and grandparents.
And there's clearly enough consumption of these things to maintain an already enormous and rapidly growing industry.
At the same time, I do think there's also a paralysis caused by this breadth of choice and people's uncertainty about healthcare evidence. One feeds off the other. It was easy when "the doctor knew best", but who believes that any more?
As to the inequity of it all, of course what we have now offers choice for the white worried well and the creaking public health system for the rest (where, indeed there is any public health system at all!). And we know it's getting worse.
My point really is that a return to the idea of full comprehensive healthcare doesn't appear to be an option any more, not just because of neoliberalism but also the decades of eviscerating and, in my opinion, quite justified attacks by left/progressive critical sociologists on the elite health professions.
So, given that, what would, could, should good healthcare look like if our attitude is not just going to be that the devil can take the hindmost?
Presumably it's going to look even worse than it currently does, except for the wealthiest and most powerful who can design a private system in their own image. Why have we given up on the notion of comprehensive healthcare? Were the sociologists' attacks intended to dismantle the system or improve it? As far as I'm concerned, the doctor most definitely knows best and I wish there were more of them working for the NHS, being paid appropriately and given the resources they need. If only NHS dentists weren't a thing of the past!
I totally understand the sentiment Jon, and we’ve both benefited from the genius of medicine and surgery over the years, but I think there’s a false dichotomy here between doctors (good) and neoliberalism (bad).
Medicine is not as separate from politics and economics as you imply. And many of the people who would disagree with your argument that the doctor knows best and should be given more rope are some of the very people I know you passionately support: victims of institutional mental health care; victims of the opioid crisis, the Bristol baby heart scandal, thalidomide; Indigenous communities and other victims of medicine’s legacy of soft colonisation; advocates for non-Western approaches to medicine; black and ethnic minority communities and other victims of systematic medical eugenics; people with medically ‘invisible’ illnesses (chronic fatigue, fibromyalgia, chronic pain); women who have experienced generations of patriarchal medical stigma; victims of medicine’s homo- and trans-phobia; AIDS victims and the queer community at large; disabled people and other victims of medicine’s normalising and ableist attitudes towards the body, and so on.
Those sociologists’ attacks weren’t intended to dismantle the system, but to make it less hegemonic, more equitable. But the failure, it seems to me, was not to define a viable, inclusive alternative that wouldn’t later be hijacked by neoliberalism. In the end, it was.
In the wake of this, I don’t think it follows that we’ll go back to a doctor-knows-best model. I just don’t think people will ignore the abuses or want to be that passive again (until they’re desperately ill and have no choice, of course).
So, here we are again, in the death throws of late-stage capitalism, looking for an approach to healthcare (and the public good generally), that is diverse and inclusive and doesn’t repeat the mistakes of the past. Perhaps this time it won’t, can’t come from the white worried well, but will be a revolution from the underserved?
The principle of public healthcare, funded by taxation, free at the point of delivery is still worth fighting for. I certainly don’t believe that medicine is separate from politics and economics - quite the reverse. Medicine, like education, is a political football and suffers from similar short-termism and a revolving door of secretaries of state. Clearly there have been major injustices and terrible tragedies but I would argue that the benefits of the NHS have far outweighed the problems. The key question remains, if I’m seriously ill, where do I go, and who pays for my care? We need a grown-up conversation about how this will be properly funded for an ageing population. For me, the answer must be a national health service that reflects the population at large in terms of its practitioners and practices.
What choices do most people have with regard to healthcare?
There's a host of answers to this I think, Jon. Are you pointing your question in a specific direction?
I’m wondering whether the neoliberal “explosion of personal choice” applies to healthcare. Are people really “overwhelmed by their options”? Don’t most people rely on a creaking public health service? Is choice reserved only for the wealthy who can afford private healthcare?
I'd say it's a bit of both.
With just a quick look I can see 20+ gymnasiums, 15+ mental health specialists, 2 nutritionists, 3 acupuncturists, gynaecologists, physiotherapists, 4 traditional Chinese medicine practitioners, skin specialists, sports medicine doctors, and Ayurvedic practitioners all within 10 miles of where you live. That doesn't include the millions of health advice websites, IG and Pinterest pages, YouTube channels and consumer health magazines that people are now using.
So, clearly there's a lot more 'consumer' choice than would have been available to our parents and grandparents.
And there's clearly enough consumption of these things to maintain an already enormous and rapidly growing industry.
At the same time, I do think there's also a paralysis caused by this breadth of choice and people's uncertainty about healthcare evidence. One feeds off the other. It was easy when "the doctor knew best", but who believes that any more?
As to the inequity of it all, of course what we have now offers choice for the white worried well and the creaking public health system for the rest (where, indeed there is any public health system at all!). And we know it's getting worse.
My point really is that a return to the idea of full comprehensive healthcare doesn't appear to be an option any more, not just because of neoliberalism but also the decades of eviscerating and, in my opinion, quite justified attacks by left/progressive critical sociologists on the elite health professions.
So, given that, what would, could, should good healthcare look like if our attitude is not just going to be that the devil can take the hindmost?
Presumably it's going to look even worse than it currently does, except for the wealthiest and most powerful who can design a private system in their own image. Why have we given up on the notion of comprehensive healthcare? Were the sociologists' attacks intended to dismantle the system or improve it? As far as I'm concerned, the doctor most definitely knows best and I wish there were more of them working for the NHS, being paid appropriately and given the resources they need. If only NHS dentists weren't a thing of the past!
I totally understand the sentiment Jon, and we’ve both benefited from the genius of medicine and surgery over the years, but I think there’s a false dichotomy here between doctors (good) and neoliberalism (bad).
Medicine is not as separate from politics and economics as you imply. And many of the people who would disagree with your argument that the doctor knows best and should be given more rope are some of the very people I know you passionately support: victims of institutional mental health care; victims of the opioid crisis, the Bristol baby heart scandal, thalidomide; Indigenous communities and other victims of medicine’s legacy of soft colonisation; advocates for non-Western approaches to medicine; black and ethnic minority communities and other victims of systematic medical eugenics; people with medically ‘invisible’ illnesses (chronic fatigue, fibromyalgia, chronic pain); women who have experienced generations of patriarchal medical stigma; victims of medicine’s homo- and trans-phobia; AIDS victims and the queer community at large; disabled people and other victims of medicine’s normalising and ableist attitudes towards the body, and so on.
Those sociologists’ attacks weren’t intended to dismantle the system, but to make it less hegemonic, more equitable. But the failure, it seems to me, was not to define a viable, inclusive alternative that wouldn’t later be hijacked by neoliberalism. In the end, it was.
In the wake of this, I don’t think it follows that we’ll go back to a doctor-knows-best model. I just don’t think people will ignore the abuses or want to be that passive again (until they’re desperately ill and have no choice, of course).
So, here we are again, in the death throws of late-stage capitalism, looking for an approach to healthcare (and the public good generally), that is diverse and inclusive and doesn’t repeat the mistakes of the past. Perhaps this time it won’t, can’t come from the white worried well, but will be a revolution from the underserved?
The principle of public healthcare, funded by taxation, free at the point of delivery is still worth fighting for. I certainly don’t believe that medicine is separate from politics and economics - quite the reverse. Medicine, like education, is a political football and suffers from similar short-termism and a revolving door of secretaries of state. Clearly there have been major injustices and terrible tragedies but I would argue that the benefits of the NHS have far outweighed the problems. The key question remains, if I’m seriously ill, where do I go, and who pays for my care? We need a grown-up conversation about how this will be properly funded for an ageing population. For me, the answer must be a national health service that reflects the population at large in terms of its practitioners and practices.