With the first heart attack, stroke, or other cardiovascular event, a flood of motivation to tackle lifestyle factors is released. At least that’s what GPs said when we asked them. Throw in some thrombolysis and a stent or two and suddenly there is no problem talking to patients about diet, exercise, weight loss, smoking and other lifestyle measures. Until then, many GPs are struggling to make inroads and given their time pressures, they may need a hand to recognise those opportune moments.

As a profession, why are we bothering with lifestyle factors? Are we simply not moving the zero point on the graph and delaying the inevitable with these people ending up in similar dire straits in 10-15 years’ time. But hold on a minute! What if they have a better quality of life during those 10 years? Kicking the footy with grandchildren surely has value even though it doesn’t free up someone else to increase the GDP.

The politicians have left their run a bit late. Rationing (by any euphemism) is now the imperative. However, there seems no hint of this in the private hospital cafeterias, full of greying people paying to stay alive and keep fit. There is no shortage of medicos willing to help them. It’s a thriving industry and it’s happening now.

BUPA is pushing for open referrals where consumers decide the right specialist for them. On what criteria, some ask – the receptionist, magazines in the waiting room, cost, wait times… This consumerism may seem silly but is there a role for the gatekeeper GP?

Maybe we can let the consumer choose for the mundane health problems, but for the more serious specialist referral the GP will get to know and understand (if they don’t already) who is conscientious and good at their job. More than that, a good GP will build rapport with those specialists. His/her value is not reflected by the number of ‘likes’ on Facebook.

I didn’t think there were philosophical differences on political sides until I heard a bigot from one side wade into the opposition on Q&A and a bigot from the other side do likewise. It was bigots at 40 paces! There are philosophical and political differences in the medical profession too but it is not so obvious and evidence-based medicine is eating into those differences. General practitioners, on the one hand, tend to help the down and outs and are seen as underachievers hamstrung by a lack of resources while specialists, on the other, are seen as high achievers with more resources and appear often to compete with each other and their registrars for top spot.

On both sides we have people who take an inspired global view who are not immersed in vested interests. But they are few and far between. We need to nurture these people and trust them.

Altruism amongst medical professionals is harder to define. Maybe legal protectionism has taken over, or less altruism simply reflects the pace and size of changes? Whatever the reason, technology is taking over. Some say that is a good thing but others mention the mobile phones on commuting trains and lament the fact that we seem to be losing the art of simple things like holding a conversation.

These are desperate times in health. Will new technology get us where we need to go? Will reliance on evidence-based medicine serve the profession well? There are many more questions. The people with the global view, with an eye on costs (but money is not king), are needed more than ever. Here’s hoping they are relatively young people with wisdom beyond their years.

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