This is the story of a patient with a wart who is rejected by five departments of a National Health Service.
Firstly, the family doctor prescribes a cream for external use that is of low cost to the health service but unpleasant to use – so is of high cost for the user. After it is seen to be inefficient, the patient is sent to a surgeon who removes the wart surgically. Since it is a large wart and treatment is given in the outpatients’ department, the doctor does not remove the entire wart and warns the patient that it is likely to reappear in which case he should return for a second surgical treatment before it grows too large. When the time comes, he is treated by a different doctor who considers—perhaps in view of the large number of people in the waiting-room—that he should be seen in the dermatology department. So the patient has to return to his family doctor in order to gain access to a dermatologist. The latter then prescribes the same, inefficient treatment that was initially prescribed by the family doctor.
Guide for discussion
Who has the best information to determine which treatment is the best? How can this be taken into account? More abstractly, is this a problem of “coordination” or “motivation”? How this problem could be solved from both points of view?