So I’ve got a documentary on Radio 4 at 8pm this evening on incapacity benefit, and it’s a bit of a veer from the norm, because it’s a subject where I’m not entirely sure what I think.
Here’s why I care. I once sat drinking with a group of medics, arguing over what would be the single contemporary medical activity that future generations would look back on with horror, and think, “what, on earth, were you playing at?” Would it be another thalidomide, or perhaps a social issue that doctors blindly and obediently waded in on, like when we unhelpfully tried to electrocute gay people straight. The answer we came up with was “nurse-led prescribing”.
Only kidding (I quite like nurse prescribing).
But weirdly, a leading suggestion was incapacity benefit. I don’t know if it’s true that it is the greatest harm we do – I’m pretty sure it’s not – but the whole area is certainly a source of some anxiety and concern for doctors, for a lot of complicated reasons.
Some of us feel that as a profession we have collectively participated in medicalising a social problem; that it’s horrible to be anything approaching a gatekeeper to benefits; and that sometimes, although time off work can be valuable and necessary, it might also, sometimes, be harmful. It’s a chilling thought – but a common phenomenon in medicine – that when you think you are doing good, you are actually doing some harm. This will not be true in all cases, and people on IB are a hugely diverse group, but like with drug side effects, it may be true of some, and it is certainly worth thinking about.
There are 2.6 million people on incapacity benefit today, after all, the largest single group of workless people, and every practical aspect of their lives, their housing, their income, their social role, is founded in an ongoing belief in themselves as incapable people, sanctioned by doctors. We haven’t really researched what the consequences of that will be.
This is a contentious area, and although I don’t think we say anything very provocative, we will receive, undoubtedly, a deluge of angry complaints from people who accuse us of saying things we haven’t said, or think we are challenging their view of their own illness, which we’re plainly not. To be honest, our greatest crime, in what I suspect is not my most stimulating 27 minutes on radio, is that we don’t really say very much at all.
Anyway, here’s a link, and I hope you enjoy it.