The end of health.

Recently I fractured a tooth. I was going to book an appointment with my usual dentist when a friend recommended his own dentist, promising me I would get outstanding treatment. I thought it worth a try, and made a booking. Before my appointment I had to fill in a long questionnaire about my medical and dental history. When I arrived I found splendid premises and magnificent equipment. The dentist gave me the longest and most thorough examination of my dental and oral health I have ever had, followed by x-rays and ultrasound images. He sat me down and explained his findings, which included not only the broken tooth but a lot of cavities and fillings in need of replacement or investigation, as well as some gum disease and discolouration. I was very impressed. He fed this data into a computer and printed out his recommendations: 10 appointments with himself and five with his dental hygienist, at a predicted cost to me of £5300 (minus whatever my dental insurance would cover). I asked him if he could possibly just sort out the broken tooth for the time being. He looked at me sternly and warned me about the possible consequences of living with so much disease and decay in my mouth. I went back to see my old dentistdwho has kindly fixed the fractured tooth in three appointments at a 10th of the cost. I don’t feel at all critical of the expensive dentist. From what I understand he is providing the nearest to dental perfection that is currently availabledit’s just that I wasn’t particularly seeking that for myself. And I probably would have thought no more of the encounter, if a colleague hadn’t sent me a paper the following week that shed some interesting light on what had happened. The paper wasn’t about dentistry at all, but about healthcare utilisation generally. The writer is a psychiatrist called Thomas Maier, from Lausanne in Switzerland. MODERN HEALTHCARE Maier has taken ideas from both systems theory and psychoanalysis to look at the way people use health services. He argues that everyone in modern industrial societiesdboth patients and health professionalsdhas become caught up in a dichotomy between seeing things as either ‘healthy ’ or ‘ill’ and increasingly defining everyone and everything as falling on the ‘ill’ side of the line. He points out that: “The intensified, obsessive effort of modern healthcare to discriminate the healthy from the ill can be demonstrated in various tendencies and developments of contemporary medicine (many of them enhanced by corresponding changes in public opinion and the legal system).” Among the examples Maier offers for this are: