The doctors are wrong, but so is the system So I moved to Italy, with my pots of stinking, sticky coal tar. And there I finally lost my childhood faith in the innate superiority of the British GP system and our system of primary health care. First of all, I was exposed to something denied to citizens of the west of Scotland through no act of political malice: sunshine. I didn't know then - no one had ever thought to mention - that UV rays, whatever their deleterious effects later in life, are an effective combatant for the skin conditions I suffered. More importantly, I met two almost-angels. Trying to navigate access to health care while you're alone in a new country and still struggling with sentences as straightforward as "How much are your artichokes?" is difficult. Fortunately, Monica and Fabio took charge of me, whether through pity at my cluelessness or nostalgia for their exchange year in Glasgow in the 1980s, I don't know. But they - well, they didn't save my life; that would be hyperbole. But their help made it manageable. In between helping me find a flat to rent and a car to buy, they explained the set-up with Italian GPs. I told them that I needed to see one quite soon, because of my condition, and my dwindling supply of coal tar. It's quite instructive to compare what happened with our own primary system; on the surface it seems similar. In fact it's radically different. Monica took me to Dr Zonzi in his studio medico and translated my medical history. He gave me the usual cursory examination, snorted at the coal tar, and then inquired, via my translating friend: "Would I like a referral letter straight to the local dermatology clinic at the hospital? Or would I prefer to see a consultant privately? In 10 minutes I was granted access to the sort of specialist it had taken years to see in Glasgow (no one I subsequently saw ever mentioned coal tar again). What's more, I was free to take the referral letter to any dermatologist I desired. But what was the significant difference? This is the part very alien to a Briton raised on the "free at the point of delivery" mantra. Dr Zonzi's consultation wasn't free to me, as a foreigner. I paid him 40,000 lire for his time, then and there, handed over in bank notes. Forty thousand lire - about £17 (in 1994 money). But the act of paying had a transformative impact on the relationship between GP and patient. The former is no less the professional expert; but the latter is no longer a desperate supplicant: "Please sir, may I have some health care?" I can't help but contrast that with my experience in Britain, any more than I can doubt that part of the explanation for that professional relationship's success was a function of the fact that I paid him, directly, for his services and his time. I'm sure there are excellent GPs who give the lie to my British experience, though I'm afraid my interactions with them since coming home haven't changed my view. And in my private working life I've had the advantage to work with many physician scientists and clinicians whose tangible concern for their patients has given their entire life its primary purpose: almost-angels, like Monica and Fabio, movingly human in their compassion. But I wonder about our GPs and their gate-keeping role with regard to consultants. That such a role is necessary in a rationed system like the NHS is incontrovertible, of course. But too many friends make too many repeat, frustrating visits to GPs, banging their heads until granted the referral everyone knows they need. To use the rancid language of economics, British GPs can give the impression of being on the side of the "producers," whether hospital consultants or health authorities, rather than the "consumers" - that is, those who pay for the entire system. That is, the patient in front of them. That the GPs went on strike to preserve their absurd pensions, behaving like militant bus drivers, does nothing, I'm afraid, to attenuate that distrust. That so few doctors obeyed the call to "action" of their increasingly ludicrous trade union gives at least small cause for optimism.