Published: 14/04/2005, Volume II5, No. 5951 Page 38

The glorification of consumption serves a useful political end. Its usurping of the central position once occupied by production switches the public's focus from work to leisure. If we live to consume, how fulfilling our jobs are becomes secondary to what we can buy with our earnings.

Michael Keaney of Glasgow University questions the rise of the patient as consumer in the NHS in the International Journal of Social Economics. Although patient choice is a key priority, what is not commonly understood is the fundamental shift in thinking to treat patients as consumers.

Part of this new ethos of consumerism, which can be enhanced only in a competitive environment, means that league tables of performance must be published, charting the relative success or failure of hospitals and clinicians.

But perhaps the analogy between patient and consumer has been driven too far.

The study of medicine requires more time at university and in postgraduate training than practically any other discipline. The total knowledge base of some branches, such as biochemistry, is doubling in size every few years. Is it really the case that the concept of an informed consumer capable of making good choices in this environment has any kind of meaning, as opposed to someone attempting to buy a car?

Unlike your relationship with your local car dealer, it is likely to be in your interest to maintain a long-term affiliation with your GP or specialist if you have ongoing healthcare needs.

It is this relationship that the NHS, in regarding its users as patients, has excelled at. The relationship between the GP and their patient, when it is working, is envied around the world.

Yet despite the grave implications, public sector service users are increasingly being referred to as customers. Could this fundamentally be to the detriment of the doctor-patient relationship?

I do not want to be a customer. I would much prefer to stay a patient.

Ironically, patients may not be given that choice.

Dr Raj Persaud is consultant psychiatrist at South London and Maudsley trust and Gresham professor for public understanding of psychiatry.