The biggest conflict of interest

Disclosure of conflict of interest is all the rage these days, and rightly so. Authors of BMJ articles are required to disclose any potential competing interests, as I have done at the bottom of this article. It's a paradox, then, that one of the most profound conflicts of interest to afflict general practitioners—one that over-rides almost all others in its power to confound decision making—remains not just largely undeclared but largely unrecognised, especially by the general public. I am talking of the pressure exerted daily on GPs to care for the public health of the nation (and, often, the political needs of the governing party) while trying to do their best for the personal health needs of the individual patient sitting in front of them.

The interests of the nation (ensuring that treatments are maximally cost effective, rationing access to scarce and expensive resources) and the interests of the governing party (ensuring that politically proclaimed health targets are met) are often diametrically opposed to those of individual patients (who want the best treatment available, …