The blame game
It is always useful (and easier) to blame someone else for an unpopular decision, or if something goes wrong. Politicians surely do it, but then so do GPs - and I guess most of us have used this strategy at some point. After all, it is easy to blame someone else, especially if that someone is a big faceless organisation distant from the discussion taking place.
If a GP has to take an awkward decision that makes the patient - and GP themselves - feel uncomfortable or unhappy, then it may well be easier to place the blame on another party. Typical scapegoats are politicians (the Prime Minister in particular is a good figurehead), the local health organisation (sometimes seen by the public as an extension of central government), or, occasionally, the media.
So it was interesting to read about a study covered recently in a univadis GP News report with the headline "GPs 'deflect blame for rationing' " (click here). In this case, the main scapegoat was paperwork.
The article reports: "GPs often cite organisational policies and guidelines when declining patients' requests for treatments, as a means of preserving the doctor-patient relationship, according to qualitative research."
One of the reasons for deflecting blame in these situations is to avoid an argument with a patient. A difficult consultation can lead to GP stress. Stress in turn can lead to burnout, an area that was also covered recently in the univadis GP News (click here). According to the research, "almost half of the GPs... surveyed fitted criteria for emotional exhaustion, while around four out of 10 reported depersonalisation and three out of 10 reported low levels of personal accomplishment".
Taking all this together then, perhaps (and this is only my theory) a key reason why we deflect blame is to protect ourselves. GPs have an important gatekeeper role that can conflict with the position of being the patient advocate. We are constantly being reminded about the need to keep down prescribing costs and referral rates. Equally, however, we are also reminded that we must do our best for the patient, and it is not always easy to satisfy all these demands. So to cope with the stress of this, we just blame someone else.
As pointed out in the initial univadis GP News story, the problem with this strategy in future could lie with local commissioning groups. It will be harder to blame them if they are GP-run and GPs commission the services. I suppose the simple answer then will be to blame the politicians!
Dr Harry Brown, editor-in-chief univadis
By Dr Harry Brown