Leatherhead Matters

The Government want GPs to weed out individuals claiming benefit by requiring them to complete a revised “Sick” Note. GPs have a historic duty of care for patients which will be compromised by this media stunt. Read this case note from Dr Crippen an NHS GP on why the Government is again saying one thing to the media and practicing something entirely different in its own agencies

Sarah is 55.
She works in security at Birmingham Airport. If a female causes a “beep” as she goes through, Sarah does the body check. She has been working at the airport for 18 years. Before that, she worked for W.H. Smiths. In her late thirties she had the best part of a year off work when she went into renal failure during her second pregnancy. She recovered but with compromised renal function and hypertension. I have been seeing her regularly for years. She is intelligent, conscientious and she does not take time off work with coughs and colds. Sadly, over the last two years, her kidneys have packed up and she is on peritoneal dialysis (PD). To complicate matters further she has developed diabetes. During the three months when she was approaching PD she felt wretched and had long periods of work. As soon as the PD started she picked up dramatically.
Her employers at the airport treated her fairly. They offered her early retirement on medical grounds with an augmented pension. She had no idea if she would ever be able to work again, and so she took it. She is a single mother. Her ex-husband departed many years ago, and she has brought up two boys single headedly. They are both now at University. Sarah is proud of them. They have their student loans but she tries to help them financially as often as she can, which is not as often as she would like.
Sarah cannot manage on her pension. She was not a high earner and even with the augmentation, the pension it is not enough. She needs to work. Also, she wants to work. She signed on, and has been actively “jobseeking”. She has been for numerous interviews but, as soon as she talks about dialysis, she can see the employer’s faces fall. She has become dispirited. She is not used to being unemployed. She came to see me yesterday. She has just had another interview with the Jobseeker Commissar. She had previously told them she had been off work with “kidney problems” but had not gone into details. Yesterday, she did. The commissar’s reaction was immediate.

“Go and see your doctor and tell him (tell him, note) to sign you off work so that you can get invalidity benefit.”

Naturally, I refused. I do not need directions from Alan Johnson. I know what my job is. I have no time for the work-shy. Sarah needs to be taught a lesson, so this is what I said to her:

“It’s idle benefit scrounging scum like you who are bringing this country to its knees. Why should the taxpayer featherbed idle malingerers like you? Stop whinging and get behind a till at Tesco. Do something with your life, you indolent sod. People like you make me sick.”

Oddly, that is not true. I signed her off work for six months, and I shall keep her signed off until she gets her transplant or reaches retirement age.
This is a classic example of government hypocrisy. GPs are being blamed by Alan Johnson and the DOH for the high number of people drawing invalidly benefit but at the same time another branch of government is pressurising the unemployed, and their doctors, to get people onto invalidity benefit. It makes the unemployment figures look better.
GPs will not act as government police officers. We act for our patients not for the government. I will not deliberately issue a fraudulent certificate, but I will always give the benefit of the doubt to my patient. And “Renal failure – peritoneal dialysis & diabetes” in a 55 year old is unchallengeable on a certificate. Sarah will not be called for an independent medical. Sarah is ready, willing and able to work “with limitations.” Who does get called for medicals? Often it is those with chronic mental illness which the inexperienced doctors who work for the benefits agencies do not have the skills or often the understanding of English to assess properly. It is so much easier to take benefits off a schizophrenic.
Soon, of course, GPs will be gone. Patients such as Sarah will see some callous, protocol driven quacktitioner at the polyclinic who knows nothing of their previous life and will not hesitate to offer a “wellness” certificate. There will be a financial bonus for quacktitioners who hit government defined wellness certificate targets.
I want no part of this health policing.

50 years ago, on average, boys  & girls educational achievements were almost identical although fewer females went on to study at university and entered the work force.

Two  movements have transformed the landscape. The first has been a legislative drive for equal rights, which has progressively become a statutory assumption of unequal treatment of females unless it can be proven otherwise. The second has been a change in societal expectations of females .

The progress over the last 50 years, in the emancipation of  women has been spectacular, although many might argue too slow.

But, what has been happening to males during this era of progress for women?

Boys today are increasingly alienated from school. Recent investigations have shown a dramatic drop over the past twenty years in boys’ academic performance in both UK & American schools. According to the United States Department of Education, the average eleventh-grade American boy now writes at the same level as the average eighth-grade girl.

Similar gender gaps have been documented in the United Kingdom, Australia, New Zealand, and Canada. In the UK there has been a long-standing gender gap at GCSE for those attaining 5+ A*-C.  Since 1988, on the threshold measure of 5+ A-C GCSEs, a significant gender gap in favour of girls has emerged. This gap quickly increased and subsequently became stable at around a 10 percentage points difference, with little variation since 1995.

The Dept for Education & Skills notes in their 2007 report Gender & Education:

“the gender gap arises mainly because of differences between boys and girls in language and literacy skills reflected in differences in performance in English and other subjects which are literacy based. The gender gap is small or negligible for Maths and Science. These general trends are very strong both from historical data going back 60 years and from international data.”

Note: the report excludes mention of the increasing proportion of the curriculum which language & literacy skills related courses represent. The DoE report diminishes concern for the gender gap by rationalising that social class & poverty are more important predictors!

And the percentage of boys going on to university and graduating from university, is falling. The U.S. Department of Education now projects that in the year 2011, there will be 140 women graduating from college for every 100 men — very nearly a 60/40 female-to-male ratio. A similar trend is emerging in the UK.

So how do we explain the educational, under performance of boys and young men? Perhaps it’s history repeating itself. Towards the end of the 19th century western society was in transition from an agrarian to an industrial society.

Men were portrayed as wimps, small minded, and lacking. The most famous caricature was the Gibson Girl, a beautiful but, also intelligent, strong and assertive woman, who was commonly portrayed next to a weakling, passive man. Turn the calendar to the 21st century and TV commercials portrays men as buffoons, only interested in beer & football.

It’s predominantly boys who get into trouble at school (and always have). They test boundaries and they explore (consistent with their hunter/gatherer ancestors). However, the majority of teachers are now female. Boys behaviour is perceived as disruptive by many female teachers. Surveys suggest both boys and girls perceive teachers as favouring girls over boys.

Where are the male role models? There are an increasing  number of single parent families, with mothers as the “in residence” parent. As noted above, females now dominate the teaching profession.

Until there is a determined focus by parents, educational professionals and Government on the gender gap many of our boys will unnecessarily, under achieve. What will it take to change the historic (last 50 years) focus on girls and now turn our attention also to the boys?

Health Secretary Alan Johnson wants to change Britain’s “sick note culture” into a “well note culture”.

Department of Health figures show that people who are on incapacity benefit for one year are likely to stay stay on benefit for around 8 years. Those who have been on benefit for two consecutive years or more, are more likely to die or retire than work again.

The Minister said: “”The evidence shows that far from being bad for health, work is generally good for people’s health. In fact staying in work or returning to work is often in a patient’s best interests. We want to explore what else GPs can do to change our sick note culture into a well note culture.