One stop shopping and medicine

Dr Grumble runs a one stop shop. It's very successful. The patients like it. Dr Grumble likes it. It was Doc G's idea. Medicine these days has to be like shopping. And best of all in the managers' eyes is the one stop shop. Dr Grumble knows the way managers think. He knows the buzz words that set the management alight. But even Dr G was surprised by the alacrity with which his idea was adopted.

So, you see, Dr Grumble has nothing, in principle, against adopting some ideas from the world of shopping. It can work. But is this really sensible for, say, a cholecystectomy? Lord Darzi regularly gives this as an example. He catalogues the numerous trips a patient has to make to get her gall stones fixed. In Sainsbury's you wouldn't make several trips for your shopping. That, anyway, is the Darzi line. He really can be quite beguiling. But then in Sainsbury's they won't fix your gall stones. Not yet anyway. And you don't have your gall stones done every week.

Not only do you not have your gall stones done every week, you don't actually go to your GP with gall stones. You go to your GP with symptoms. Galls stones may present in different ways and the same symptom could have a number of different causes. Abdominal pain could be gall stones. It could be a heart attack. It could be nothing much at all. It could be numerous other things. It could even be cancer. That's why you need a GP. You can't just look up which expert to see on the internet. You really can't.

But if Lord Darzi had his way you would enter the one stop shop with tummy ache, have an ultrasound to confirm your gall stones and leave with your gall stones in a jar. And, of course, there would be no need for any follow up just to tell you that Lord Darzi has done a good job. This is brain stem thinking. A lot of people have tummy ache. A lot of people have gall stones. Quite a few people who have their gall stones removed still have the tummy ache. The gall stones, you see, were not the cause. It's just not that simple. But if you are a one stop surgeon you will never find that out.

Please, Lord Darzi, medicine is just not like this. Surely you know. Have your political masters bamboozled you with the results of their focus groups? If you ask people if they would like their gall stones done in a one stop shop instead of several visits, they will answer yes. But this does not mean they have thought it through. It doesn't make it sensible. Your job, Lord Darzi, is to put some sense into this madness. Please.