Health: Stitch me up, nurse

IT WAS what doctors describe as a "superficial wound" but you and I would call a nasty gash. I had dropped a glass bowl, tried to save it and in doing so carved a slice out of my thumb as it broke. It left me bleeding into the sink, and took me for my first visit to a casualty department for at least a decade.

The most striking change in that time - to my semi-professional eye - was the growth of defensive medicine. I was overwhelmed by the generosity of the NHS.

At the reception desk three people busied themselves with filing, tapping at their computers and making telephone calls. I waited, ignored. Eventually I was offered an X-ray to check for glass fragments, a local anaesthetic, antibiotics and painkillers. I turned them all down and said, trying not to sound ungrateful, that if they could just stitch me up, that would be fine.

One of the nurses congratulated me. "Well done for saving the NHS money," she said.

My motives were in fact entirely selfish. I refused the X-ray because I thought it would keep me waiting twice as long. I guessed the anaesthetic would cause as much pain as it would save. Antibiotics make me feel rotten, and anyhow we shouldn't be adding to the global antibiotic soup in which we are all now bathed. And I turned down the painkillers because I was not in pain.

I wonder how much I saved. Multiplied several million times, those four items add up to a lot of cash for an uncertain health gain. So why not, instead of ordering these measures for every patient, promise that every X-ray refused, every antibiotic saved, will go towards a Christmas bonus for casualty receptionists who muster a sympathetic smile?