The doctor/patient relationship: class war

…yes of course, how insightful of you…

You know when a consultation has run its course when your inner Tourette kicks in.** The scenario is nearly always the same: a straightforward clinical problem, treatment commenced or completed, nothing to report basically…but then it begins, a series of minor questions/points half of which have already been dealt with. The consultation doubles to 20 minutes or more, outside the waiting room is full and getting restless, and that silent voice in your head starts yelling. Please, just **** off.

I accept that this reflects badly on me. I’m only human.

The thing about it though, is that it’s always a particular type that brings it on. It’s not the punters, it’s not the occasional toffs, it’s the middle class.

Now,  The Knife was raised in the middle class, I live in the middle class, my offspring are exceptionally middle class. However, I like to think that my professional insight has prevented me, so far, from inflicting my “I- know-best-because-I’m-educated-not-like-your-usual-client” views on whichever teacher/doctor/manager that I’m speaking to. Why do these people think give the impression that they know there’s a vast conspiracy against them by the medical profession, and they’re too smart to be suckered by it?

I first encountered this as a junior doctor, in an outpatient clinic. The young patient was fine after their treatment, so discharged after the necessary assessment. All well. The father looked at junior me, with a degree of hostility “I should tell you that I’m a friend of Mr ******”. He was the consultant.

Pardon? What was I supposed to say? That I was stringing them along  and they’d found me out? Incredibly this scenario happened twice that month, and there was no clinical issue at all. Conversely, even the lowest of  lowlife junkies is usually perfectly OK in the same situation.

I’ve blogged on this before, and in that post quoted the wonderful Brendan O’Neill, and he’s back on topic:

Strikingly, while chavs and toffs might come from spectacularly different sides of the tracks, they’re attacked for the same reasons. Both are viewed as creepily materialistic. Chavs are lambasted for lusting after Nike trainers and chunky jewellery (even their alleged champion, the leftist author Owen Jones, wrings his hands over their desire for ‘more material things’). Toffs are frowned upon for blowing small fortunes in shopping sprees on Old Bond Street.

Both are condemned for being insufficiently eco-friendly. Chavs are attacked for taking carbon-puking cheap flights to cities in Eastern Europe, ‘destinations chosen not for their architecture or culture but because people can fly there for 99p and get loaded for a tenner’, in the snobbish words of the achingly middle-class anti-flying group Plane Stupid. Meanwhile, posh people who drive 4x4s — the Guardian sniffily refers to them as ‘Chelsea mums’ — are accused of polluting cities.

Both chavs and toffs are considered cruel to animals. The RSPCA now pretty much divides its time between roaming inner-city estates for signs of abuse against ‘dangerous dogs’ and moaning about poshos who long for a return of foxhunting. Both groups are seen as having a problem with drink: government attacks on cheap beer and the constant media hunt for a photo of a Tory holding a glass of Bolly suggest that both lower-order and upper-class boozing is something disgusting and shameful. Both are laughed at for giving their kids stupid names, whether it’s the chavvy Kaylee or the horsey Annunziata. Earlier this month, the Daily Mail reported that some poor kids are stuck in care because middle-class wannabe parents don’t want to adopt children with names like Chrystal or Chardonnay (adoptive parents aren’t allowed to change children’s names).

And both are mocked for being thick. Consider two of the best-known comic creations of recent years: Matt Lucas’s vulgar-tongued Vicky Pollard, who swaps her babies for Westlife CDs, and Harry Enfield’s Tim Nice But Dim, an utterly clueless upper-class twit who is forever making social cock-ups. Those two characters sum up how the respectable (read middle) classes now view the Great Unwashed and the Moneyed.

In essence, chavs and toffs are hated for sinning against the middle-class moralism that dominates modern Britain. Where the do-gooding classes implore us to be thrifty, eco-decent, permanently sober and PC, chavs and toffs insist on blowing their cash on nice stuff, blowing exhaust fumes into Gaia’s face, and getting pissed. And long may it last. Rather than give in to their haters, chavs and toffs should join forces, link arms across the tracks, and say a collective ‘screw you’ to the middle-class miserabilists who want everyone to be as sappy as them.

Of course it’s the small minority who behave this way, and it’s the relatives, almost never the patient, but it’s a real phenomenon. These are also the people who write the most vicious and ill-informed garbage about doctors’ pensions – as one example – on online comment pages in the Independent and elsewhere. Nasty stuff.

This isn’t just class war, it’s class civil war.


**In case anyone is offended, I know Tourette’s is no fun. Colloquial usage only.


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