Jill Palmer On patient obligations

Published: 22/07/2004, Volume II4, No. 5915 Page 19

You eat, drink and smoke too much and generally enjoy the good life.You always mean to exercise but somehow you can never quite find the time.Your behaviour is foolish, but does it mean you should be denied medical care?

The public debate on rights and responsibilities is back at the top of the NHS agenda. Now health academics at Birmingham University have published a paper on citizens' obligations to take care of their own health and to use health services responsibly.

There is absolutely no excuse for misusing the NHS. But some of the blame lies with the NHS itself. It is bad manners not to turn up for anything, but when you receive your NHS appointment weeks or even months in advance it is easy to forget.My dentist - private, of course, as there are no NHS dentists in my area - telephones patients 24 hours before an appointment to remind them.Why can hospital outpatient clinics and GP surgeries not do the same?

Obviously it would cost the salary of the person making the phone calls, but surely this would more than make up for the cost of missed appointments.

Every year Developing Patient Partnerships, formerly the Doctor Patient Partnership, runs a winter campaign discouraging people from visiting their GP for antibiotics for viral infections. I remember a reader calling me at the Daily Mirror after I had publicised this, shouting and swearing that he paid his national insurance and if he wanted to go to the GP and demand antibiotics he had the right to do so.

Thankfully I believe he was in the minority.

However, it is human nature not to value something you get for free. Being responsible for your own health is a completely different matter.

There cannot be a person in the land who does not know the dangers of smoking, excessive alcohol consumption, unprotected sex, and obesity, yet all these risky behaviour patterns are rising.

Would it make any difference if the public thought these activities would disqualify them from NHS treatment? Probably not, because 'It will not happen to me'. No alcoholic believes they will get cirrhosis of the liver, no sexually active girl believes she will get chlamydia.

And if people who smoke are denied or charged for treatment, what about people who like dangerous sports? Then there are those who cannot uphold obligations to be responsible for their health, either through poverty or lack of knowledge or cost of travel to places where cheap healthy food or exercise opportunities are available.

One lovely lady reader telephoned me at the Mirror and told me she did not realise her diet was unhealthy until she read a piece I had written. The only fruit and vegetables in her diet were frozen peas once a day and the occasional banana sandwich. She wasn't stupid. She had simply never been taught.You cannot be responsible for your own health when you do not know how to.

We, as a nation, have to overcome that hurdle first.

Jill Palmer is former health editor of The Mirror.