An insight into what could be termed the ‘under-the-radar‘ approach to undermining the integrity of medical personnel, such as GPs, is provided by Professor Wessely’s article for Unum’s Annual Chief Medical Officer’s Report 2007 entitled “Why and When do Doctors Collude With Patients?” (The CMO for this publication was Michael O’Donnell, now occupying the same role with Atos Healthcare.)
Subtle But Significant
This notion may seem to be introduced with apparent goodwill, even humour, but the important fact is that it is introduced at all. The question should always be asked about corporately financed material “Who is set to benefit from the dissemination of these ideas?”. Is there anything to gain on the part of the Insurance firm Unum who produced the report? – Such as carving a first chink in the hitherto resilient armour of the authority of physical medicine, perhaps. This, by suggesting that doctors can be psychologically ‘vulnerable’ to forms of ‘collusion’ with those in their care in ways which might work against the patient’s welfare.
Might it not in fact be an attempt to first, construct such a thing as this type of ‘psychological failing‘ of a doctor, and second, draw it into the classification of ‘iatrogenesis‘, a term historically limited to the adverse effects on patients of drugs, medical error, or negligence through decisions taken by medical personnel. Note should be taken of Professor Wessely’s reference to the naivety of ‘ethically pure’ young doctors, new to practice, who will come to the realisation that “in real life things are not neat and simple, but grey and ambiguous”, ultimately, presumably, succumbing to this ‘necessary collusion’. Some of the reasons for colluding that Wessely lists give anything but a favourable impression of our medical practioners, including as it does such things as financial reward, lack of time and fear of complaint.
Poor NHS. Also deluded.
Just prior to introducing Professor Wessely’s article Michael O’Donnell bemoans the way that “our NHS managers [are] fixated on providing those treatments which can be measured” such as operations and injections. As opposed perhaps to psychological interventions which rest solely on, and the success of which is evaluated only by, certain ‘experts’ in that field. He then states that “until return to work is included as the objective and final measure of success, it seems likely that the NHS will continue to miss the point.” This is of course an ‘objective’ perspective, and nothing whatsoever to do with the fact that it serves insurers such as Unum’s best interests (and saves them money) to get the sick back to work.
Wessely’s ‘Previous’
If what I’m claiming seems a little exaggerated, or ‘conspiracy theory-ish’ perhaps you should also take a look at this paper by Professor Wessely from 2003. The main thrust of of which is that doctors who accept the possibility that their patients suffering from (ahem) ‘Medically Unexplained Symptoms’ (MUS) may actually be physically ill are in danger of committing an ‘iatrogenic’ offence against them. He does this by arguing that patients with ‘MUS’ conditions (an important and expensive group he alleges) are in effect made worse by doctors taking their illnesses seriously and organising physical investigations and treatments. There are, Wessely concludes, “points within the doctor-patient encounter where MUS may be iatrogenically maintained“. In simple terms, doctors need to stop ‘colluding’ with these patients because it is doing them harm.
Note: Professor Wessely’s list of MUS illnesses in the paper (detailed below) correlates very closely with those listed by fellow psychiatrist Dr Christopher Bass at the 2004 Atos Conference referenced in my earlier post. (Though he omits chronic back pain in favour of irritable bowel syndrome)
Non-cardiac chest painCaution: Unbridled Arrogance Ahead.
Fibromyalgia
Chronic fatigue syndrome
Repetitive strain injury
An unexpected interjection to the article under the sub-heading ‘Social’ is yet more evidence of just how entitled proponents of the Biopsychosocial model perceive themselves to be in stepping out of their own field and usurping theories from Sociology to twist into their arguments. Aylward from his ‘Medical’ expertise, and Wessely from Psychiatry. It is very telling indeed that there are no qualifed Sociologists involved in the Biopsychosocial lobby. A small matter of ethics, perhaps.
Wessely’s A Sociologist Now?
In this instance Wessely attempts to appropriate Ivan Illich’s notion of ‘Social Iatrogenesis‘ and ‘invent’ his own version for his own purposes.
Illich explains the meaning of his term as referring to the “impairments to health that are due precisely to those socio-economic transformations which have been made attractive, possible, or necessary by the institutional shape health care has taken“. Note the use of the word ‘institutional’ here.
Illich’s main concern is that autonomy has been removed from the people, and he speaks about the danger of ‘radical monopolies’ such as is expressed in the idea that “When cities are built around vehicles, they devalue human feet“.
Illich asserts that “Ordinary monopolies corner the market; radical monopolies disable people from doing or making things on their own”. Disregarding this core idea, Wessely feels entitled to put his own spin on ‘Social Iatrogenesis’. Describing it as “a term for illness caused or prolonged by wider sociopolitical inputs” he uses it to discredit ‘Patient Support Groups, no less! It would be quite one thing were he a qualified Sociologist to make that assertion, and accordingly be ethically required to back it up with a full argument as to why that could be a reasonable (though inexplicably contradictory) interpretation of Illich’s theory. It is quite an extraordinary presumption to appropriate that theory towards the opposite aim of its originator. Patient Support Groups are nothing if not an attempt to restore a measure of autonomy to ‘the people’ within what has become an ever more bureaucratised, institutionalised healthcare system. This is nothing short of abominable arrogance on Wessely’s part, but oh so very symptomatic of this group of ‘experts’ including Aylward et al.
Could He Possibly Be More Wrong?
Wessely just couldn’t be more wrong in citing Illich in this context, when the latter complains that the spread of medicine “turns mutual care and self-medication into misdemeanors or felonies”. Please compare against Wessely’s rubbishing in the Unum Report of any steps that that an individual may take outside of traditional medicine to ‘self-medicate’. These potential treatments he disparages as ‘”cod-immunology [mixed with] pseudo radiation science interspersed with New Age homilies” directing us towards that reknowed ‘quack-busting’ site ‘BadScience.com’. Hardly comments or sentiments in line with Illich’s philosophy is it? No, it’s quite the opposite. Perhaps Professor needs to sign up for a beginner’s course in Sociology, or better still refrain from playing with concepts that he doesn’t understand.
I’ll leave the final word to Illich on “nosology” (the system of classification of diseases, which he notes “changes with history”)
In our society nosology is almost totally medicalized; ill-health that is not labeled by the physician is written off either as malingering or as illusion.Oh deary me, Professor Wessely, oh deary me…
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