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Jumping the queue
Should medical students get preferential treatment in the NHS? Kate Mandeville considers the arguments for and against
I got a fish bone stuck in my oesophagus the other day. So I went along to the emergency department, was seen within an hour, and after much effort to juggle the burgeoning waiting list, was fitted into the gastroscopy list for the next morning. Perhaps this is due to a particularly efficient unit at my hospital, or the result of recent funding increases in the NHS. But it did make me wonder if the fact I said that I was a medical student had any influence over the speed doctors attended to me.
Taking care of our own
Many of my friends, when faced with a medical problem of their own, have made a trip to the relevant department. Here, they have invariably received prompt treatment by staff keen to help one of their own students.
One friend, after a particularly exuberant night out, visited our hospital genitourinary medicine clinic. At the reception, he mentioned that he was a medical student, and was immediately swept past hordes of other patients, fast tracked for investigations, and received reassurance in a third of the usual time. Another friend, in a similar position to me with an irritating celery particle wedged by her tonsils, popped into the ear, nose, and throat department between her clinics and had it whipped out with the aid of a flexible nasal endoscope, bypassing other patients waiting outside.
"Before we press on - are we sure he's a doctor?"
Perks of the job
Don't get me wrong--I enjoy this privilege and long may it continue until I can afford private medical insurance. After all, we are going to be doctors ourselves in a few short years, and by it you feel included in "the family."
Medical school is challenging, and being a doctor will be even tougher. There are few perks in the modern NHS. With long hours, poor conditions, and now the scrapping of on-call rooms, can anyone really begrudge us quick treatment if we become ill?
Svilena Drimitrova, in her fourth year at Imperial College, London, certainly agrees: "Of course medical student and doctors should be fast tracked. After all, we are going to spend our life working for the NHS, and it's not like we even get paid that much. The long hours, all the studying, and the debt you get into, and what--we're not even allowed to fast track? People who work in stores get store discounts, so why should we have to wait? I always fast track and would most certainly examine a patient as soon as possible if I heard that they were a colleague."
A question of logistics
But herein is another dilemma. Doctors contribute actively to keeping down the waiting lists and when fit, they can treat hundreds of patients. However, apart from those rare attachments where they are actively involved in caring for patients, medical students are not needed to the keep the waiting lists down.
The ethics
In its publication, Good Medical Practice, the UK General Medical Council states: "You must always try to give priority to the investigation and treatment of patients on the basis of their clinical need." The British Medical Association's publication, Medical Ethics Today, expands on this: "Under the NHS, the approach has been to ensure equal access to all citizens. In determining priorities between individuals for a limited resource, clinicians' assessment will give priority to the need to protect life and health, so that those whose healthcare needs are greatest or most urgent on clinical assessment will receive priority."
If the priority for treatment is based on status, this is less ethical. Johnny Beavers, the deputy welfare chairperson on the BMA Medical Students Committee, says, "Sure, it's great if you're a student. But everyone should have equal access to healthcare and jumping the queue on the basis of status is just not acceptable." What if a doctor or nurse was injured at work? Johnny Beaver concedes, "If it was just a case of giving them an eyewash and getting them back to work, then that would be more justified, but again this is not the case with medical students."
Other medical students agree that this is unethical behaviour. Ali Abdulle, a final year student from Finland, explains, "If patients see medical students getting faster treatment and doctors acting unequally, then they will lose their all important trust for their doctors. Think--if you were in their place--isn't that how you would feel?"
Anthony Fleg, a second year student at the University of North Carolina, thinks it is part of a wider problem: "This is an issue with much larger implications than just concerning medical students. I think the reality is that people are treated differently based on how they appear, with medical students being just one of the groups receiving favouritism. Someone who looks wealthy, someone who might know someone on the medical staff, or even someone who works in the hospital itself--all of these people will get preferential treatment to a certain extent." He concludes, "We as future doctors must be vigilant to the ways in which we give better or worse treatment to our patients based on the characteristics of that patient."
Even the ethicists find it a thorny issue. Piers Benn, a medical ethicist based at Imperial College, London, feels that the situation is not even clear for doctors. He says, "Priority treatment might make sense in the case of doctors, but if so they are not the only people for whom this might be appropriate. What about the many other types of service professionals--for example, fire fighters, paramedics, or the police?"
He continues, "It also might depend on what the doctors are being treated for, and whether the condition seriously compromised their ability to treat their patients. [When there are so many essential healthcare and emergency workers] it does certainly seem less justified to fast track medical students."
Representatives from the flagship UK patients' rights group, the Patients' Association, have differing views. Brenda Luther, who runs the information helplines, comments, "It would be very unfair for medical students to be given priority treatment as there are so many members of the general public waiting for treatment and operations."
On the contrary, the communications director, Katherine Murphy, has a totally different opinion. "I fully support the fast tracking of doctors and medical students. There are few rewards in the NHS, and it's a difficult career to choose. Medical students should be able to have the confidence that if you become sick during this career, to which you've devoted so much time and energy, you will be treated faster."
But is this fair to other patients? "I feel patients would be broadly in favour of it, as in the long term they will be benefiting from having more healthy, motivated doctors in the system." She said adding, "I would like to think that medical students would not abuse the system."
As Svilena Drimitrova puts it, "Of course, this doesn't mean that I want to be seen first if I have a cough, and someone next to me is having a myocardial infarction."
Opinions are split on this issue. There are people who feel that it's just a harmless reward of training to be a doctor, and choosing to put up with all that a doctor's life entails. At the other extreme are those who point to the ethics, claiming that if doctors themselves aren't seen to be ethical, who else will be?
Kate Mandeville, fourth year medical student, Imperial College, London
Email: kate.mandeville@imperial.ac.uk
studentBMJ 2005;13:1-44 January ISSN 0966-6494
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