Med School Interviews: Ethics of Private Healthcare | PostGradMedic

hi everyone oli here welcome back to the channel this time we're going to be talking about the pros and cons of private health care [Music] so private health care and its merits or lack thereof is a really really important talking point in our current geopolitical climate and I think we're reaching a point where med school interviews are more likely to be asking about it so what we're going to do in this video is have a look at some of the ethical issues involved in the provision of private health care the advantages and disadvantages that people perceive kind of of private health care and whether or not we should be encouraging our doctors or even allowing them to practice privately in the UK just a couple of points before we begin when I say private health care I mean a doctor or other health professional working outside an arrangement with the NHS that they are being paid for directly by a private member of society or organisation it's a private agreement that doesn't go through any government involvement and obviously there's a huge difference between a system that is completely privatized or more completely privatized such as the US and one where we have elements of it in the UK but we'll talk about that more as we come to it so the first part of this video is going to be about the the positive elements of private health care why might we want it why might people want to engage with it the most obvious is perhaps shorter waiting times NHS waiting lists for certain types of consultations particularly more niche and specialist areas like complex Adolescent Psychiatry or more complex elective surgery these waiting periods for this type of consult or operation can often be months or even years because there are so many people that need them and so few people who can actually provide these treatments and even then you may you know wait three months for your operation only to get there and find out that the anesthetist that was due to be on that day is sick and they were unable to find another consultant to replace them so they opted gets cancelled and pushed back even further so paying privately in this situation and having it done by a private provider means that you or your relative or whoever you want to pay for is bumped to the top of that list and you're not reliant on the government systems to deal with it and you can also argue obviously because over that if you go private instead of going through the NHS for this type of intervention you are also removed from the NHS waiting list and that means that other people even those who aren't paying for private care can be seen faster as well so it removes burden from everyone the second major talking point is usually about better facilities and more comfortable hospital stays this is a little bit controversial depending on exactly where in the country you are and who you're talking to but just generally speaking if you've ever visited an NHS ward you'll know that there they're often quite open quite disconcerting places where you'd you'd ideally not spend huge amounts of time and that's not to say that NHS hospitals aren't nice the staff do an absolutely amazing job in keeping the wards clean and well staffed and people well looked after but most people don't like being away from home . particularly if they're ill but they're not hotels their hospitals and they have to be run you know within within means private hospitals on the other hand tend to look a bit more like hotels it's just little things like you'll tend to have your own room maybe more choice of food or better quality food available and a generally nicer environment somewhere where you'd be more willing to stay it's a case of pay big bucks and get big buck rewards another talking point is alternative treatments being available under private care than with the NHS as i've just hinted at now the NHS is very much limited by fiscal budgets in everything that it does i can remind you that the the ethical principle of justice the idea that everyone gets the same quality of health care that's constrained by our tax system in the UK so we all pay in you know a roughly similar amount of national insurance we're all gonna receive approximately the same care but that means that some ludicrously expensive or personalized things can't be done because that's unfair on everyone else and in practice this means things like using generic medications the cheapest ones available where we can and the most cost effective first-line therapies and that's sensible obviously for a publicly funded system however private treatment because you have essentially as much money as you or your provider is willing to pump in that means you get access to treatments that may have a lower evidence base behind them but you would prefer and are more expensive something like cosmetic plastic surgery is a really good example of this it's a medical procedure for sure but it's not available on the NHS the only way to access these services are by finding a private plastic surgeon and then signing a contract that allows them to do the procedure in exchange for your money however other things like multiple rounds of IVF in vitro fertilization treatment also fall under this private-sector bracket depending on where you are in the country because of the postcode lottery you are only assured a certain number of goes IVF and if it's unsuccessful you can't have any more and this is simply due to how time intensive and expensive the process is but under the private sector as long as you've got the money to keep paying you could in theory have as many goes as you want you're also practically speaking get a lot more time with your doctor because they're not going to be a busy consultant running around with a task list 100 items long trying to manage the patients the juniors everything else they've got to do they're usually only concerned with a very small number of people in a private setting this means that they're able to spend more time talking to their patients which obviously means patients are better able to be informed in this situation and that can lead to better consent ultimately and a better understanding of exactly what's going to happen time constraints are a huge factor in doctors often not being able to explain things to patients properly and the last key element and the most kind of obvious one is buying power in a private service because the consumer is the one making the purchase this places all the power in their hands and it does affect the doctor-patient relationship in that sense this means that the patient is going to choose exactly where they go exactly what they have done and who their doctor is going to be and again that type of situation for better or worse is going to maximize patient autonomy and a last point you could tentatively make you could argue that if fees are charged to see a doctor full stop this means that patients are only going to go and a doctor when they feel that it's worth their investment to do so and therefore might reduce time wasting patients and you know wasted consultations as a result so now let's talk about some of the negative aspects involved with a private healthcare system now the first and most obvious problem with private health care is that it creates effectively a two-tier system wherein those with money get faster access to care and higher-quality care which just flies completely in the face of the ethical principle of Justice that we talked about before health care and the same standard of health care should ideally be accessible to everyone and that was one of the things that the NHS was set up to provide but it already is the case that your wealth is often tied to your health outcomes and under such a system that would become even worse now the second major problem is that it takes practicing doctors away from the NHS and the patients that they would be seeing as a result the NHS has a complete monopoly on medical training in the UK which I don't know I have conflicted feelings about but that's an argument for another time but the key thing about this is that it means that any doctor has to completely train in the NHS from start to finish so they go through Medical School which is funded by the NHS they have to do their junior years in the NHS and specialist training when they get to registrar and consultant level where they're kind of maximally autonomous and can do what they want to get to that point they have had to train in the NHS for a very long time and the NHS is subsidizing their training but if those doctors then decide that they're going to spend some percentage of their time or all of it not doing any work for the NHS and instead doing purely private practice and their own contractual arrangements the NHS has pumped so many resources into them and their training for them to not spend their time seeing NHS patients do you see where the problem is and because ultimately it's funded by the taxpayer that makes those doctors less good value less of a good investment and very much linked to that is the fact that private systems often pay doctors of much higher rates than the government systems can afford to for reference I think the base consultant salary in there chess is about 80 85 thousand pounds if you do private practice that same consultant could easily be earning multiple hundreds of thousands of pounds a year but this can be a problem because you could argue that it perverts the nature of the vocation of Medicine the idea that doctors are meant to become doctors because they want to help people they want to care for them want to do something worthwhile with their life not simply to make a ton of money and I'm not saying that that's a that's a wrong priority for people to hold if you want to do a career to make loads of money that's up to you you know more power to you but it's a bit of a difficult one when we're talking about something as as entwined with public well-being as medicine and healthcare and also coming back to the nature of the doctor-patient relationship private medicine can negatively affect that relationship because it turns it into a consumer agreement and not a proper medical consultation in the same way if you ask any American surgeon about how many operations over there are carried out purely for clinical necessity it will be a much smaller percentage than you'd ideally like to think that it was because it's in the best interest of not just doctors but hospitals over in the u.s. to perform as many tests and make as many interventions as they can because they can charge for each of these ones by themselves and the doctor may not have any choice as to whether or not they recommend those tests if that's what their employer dictates they have to do and I do just want to make a quick point it's not to say that all people who work in private health care do so for selfish or for bad reasons there are loads of perfectly legitimate reasons why you might want to do that you might want reduce working hours so you can spend more time with your family or in the view of families you might want to take the extra money that you get from private practice and use it for a better education for your children or maybe to pay off their mortgage or their existing student loans I know it's tempting to tar everyone who works in private healthcare with the same brush particularly in the current political climate but as with everything it's a bit more complicated than that and please don't jump to conclusions so just to focus very briefly on the privatization of the NHS and what it means in the current context it means that increasingly we're seeing more and more services contracted to the private sector so that might encompass staff hiring or covering unfilled shifts maybe the supply and research of particular drugs and medicines to the UK surgical equipment or having hospitals and the other medical amenities that you need being owned by private companies as opposed to the UK government and rather cynically what it appears has been happening particularly in the last few years I'm going to try and keep this apolitical but this is the read that I have on it it seems as though NHS spending has been systematically undercut to the point where it appears that the NHS is underachieving and because it's not received the funds that it needs and then it's very easy to say well the NHS is underachieving so we need to privatize it and bring in more competitive solutions when in reality this wouldn't have been a problem had it been funded properly in the first place but again that's a conversation for another time so just to wrap up this video I'm gonna give you my personal thoughts on private healthcare this is what I would say in an interview I think I'd argue around the points of outline so far what are my ultimate thoughts don't get me wrong I love the NHS I'm a firm believer in everything that it stands for why I'm training as a doctor why I don't want to go and work in a country outside the UK I think I owe a very very great debt to the UK taxpayer for funding my education I'm very excited to be working one day in the NHS and doing everything that I can for my patient however in its current form it's completely unsustainable it's kind of creaking along and this is my genuine read is that the NHS is only sustained by the goodwill of the people that work within it the doctors the nurses the allied health professionals that are working longer hours than they should doing more than they should and taking on more emotional burden than most people do because we all believe in this this concept the closest thing to a national religion that the UK has is the NHS and I'm a huge huge admirer of all the people that do these things to keep the system running without that goodwill it would have stopped a long time ago however do I think that private health care should be allowed to exist absolutely and this simply comes down to an autonomy argument where I don't really want the government to have the power to tell people what they can and can't do with their hard-earned qualifications and skills if I have some money that I earned myself through some vocation or work and I want to spend that money on a private arrangement with a doctor to treat myself or my family that's between me and my doctor as long as I'm suitably informed and everything's legal and aboveboard I don't think anyone should have any right to tell me that I can't do that so in practice as I say this is an autonomy issue that means bringing the bottom up as opposed to the top down and I'll illustrate this using the example of private schools because private schools create a two-tier system those that have money go to private school they get a better education than those who can't afford that same pathway but the answer there is not to ban private schools if some people want to get together in a room and work out how to game the educational system to get those kids into university that's up to them no matter what test or what series of qualifications is necessary to do something people are very smart and people are motivated by reward whether it's financial emotional social to solve problems you can't simply keep creating more problems because people are just going to solve them so I think it's about being innovative and about people who can being charitable to allow other people to succeed it's why everything on this channel is free do I dislike the expensive predatory get into medical school smash the you cat courses yes I really dislike them and the people that do them but crucially I'd never ever try to change the system such that they're not allowed to do that that would be a huge infringement on people's personal autonomy and the same has to go for health care but do we need to be careful about how far private services encroach on NHS core services yes we do because you only have to look at America and systems like that to realize that ultimately they don't work for the people that they're supposed to be looking after so our priority has to be in making sure that universal access is still available however we make that happen so thanks very much for watching guys I hope you've enjoyed that please be sure to hit that like button for me leave a comment subscribe to the channel and don't forget to go and check out post-grad Medicom for more free medical interview videos just like this if there's any topics that you'd like to hear me talk about please let me know in the comments it's your guys feedback that influences the content that I make I'm running my mock interviews as well over Christmas and into spring of 2020 I'll leave the sign up for my interviews in the description below you can go and click through that fill out your details and I'll get back to you as soon as there's a slot available take care guys and I'll see you next time if you want to support the channel there are a few ways you can go about doing that the simplest and easiest is to subscribe and like and comment and share the videos with your friends that are applying to medical school word of mouth is the biggest thing that grows the channel and I really appreciate any help with that the second thing you can do is support me on Kofi Kofi the link to that is in the description below where you can simply essentially donate the cost of a coffee to the channel and I will buy coffee with it I assure you that and the last thing you can do is that I've teamed up with complete Anatomy 2020 my favorite Anatomy 3d education simulation tool if you use the referral link in the video description below you'll save 10% of your first year using the program take care guys and I'll see you next time

Channel: Dr Ollie Burton

Views: 14,528

Keywords: ollie, burton, ollie burton, warwick medical school, leamington spa, postgradmedic, medicine, medical school, med school, vlog, blog, ollieplays, ollieguitar, graduate entry medicine, university, education, diary, graduate medicine, grad medicine, grad entry medicine, study, revision, neuroscience, anatomy, physiology

Id: 0GtKRAsHu2U

Length: 17min 24sec (1044 seconds)

Published: Fri Dec 06 2019