Despite all my other grumbles about life in Britain, this is the first time I have felt the need to grumble about the NHS on the blog. It's still free after all, and I haven't had any serious health problems in the 18 months I've been here. For some reason as I have a thyroid problem, all my prescriptions are free as well, so I don't have so much to grumble about. But almost a decade spent using private health care in countries with terrible national health systems has made me examine the way the NHS is organised. Here are some of the things I liked about my private treatment in Lithuania and Greece.
First of all, a private family doctor does not spend just 10 minutes dealing with you, no matter how many issues you need to talk to them about. I realise it is one of the privileges of paying for the doctor's visit, but it does mean you have time to ask questions and feel comfortable about the answers. This week I went with Bee to ask about endometriosis, as it seems to run in the family. My sister said that it always took a long time to get diagnosed so she should start now, just in case that was what the stomach cramps and pains were. The doctor's response was to print off a fact sheet and say "come back when you have decided how you want to proceed with treatment". Pardon me, but isn't it the doctor's job to do some diagnosis and propose the treatment, not the patient's? I suppose we should be grateful that they see that their job involves providing information and actually giving it to you to take away. On the other hand you can get a fact sheet off the internet any time. You go to the doctor for a more personal advisory relationship and some reassurance. We didn't really get that in our 10 mins, since the printer was rather slow.
Secondly, it's a well-known joke that whenever you see the doctor you get told to take paracetamol for whatever the symptoms. In both Lithuania and Greece I would come away from the doctor's with a prescription for about 4 things even for flu. Admittedly they all had to be paid for, but what with the regular medicine I take I got to learn how much things really cost, and that was quite a surprise. Medicines were not nearly so expensive as I had thought and quite often less than the prescription charge at home. By the time we came back, many of the medicines were now sold over the counter without a prescription anyway.
Further, it was possible to buy regular medicines without prescriptions, so you did not have to bother the doctor for repeat prescriptions. This was a big help for me when travelling, if I ran out unintentionally, or had forgotten something in my drug cocktail I take every morning. I can see that a lot of expensive drugs need to be controlled, as well as the narcotics, but do you really need a prescription for something to lower your blood pressure or cholesterol, or my thyroxine tablets? People still go to the doctor for checkups and pharmacists ask enough questions to make sure you really have seen a doctor and been prescribed recently. It just removes an extra layer of paperwork.
When you did go to the doctor in Lithuania, everything happened very much faster. Most blood tests could be done on the spot, some specialist doctors like gynecologists and the guy with the ultrasound came once a week to the surgery. If you needed high tech tests you either went to the specialist doctor who had the equipment, or to the diagnostics centre. Appointments were made in less than a week and you got the results back after the appointment, not six weeks later.
In Athens it was even more organised. If you wanted one test, you were offered 10. One year I needed a medical examination for insurance, which was paid for, so I had everything. It took most of the day, but I came away knowing I had no breast cancer, cervical cancer, urine infections, blood problems, my ears and eyes were OK, my heart was fine etc. There were a couple of tests where the results took a couple of extra days, so I had to go back for those, but the basic results took one day.
The following year, my doctor warned me that most of the tests weren't necessary and there was a scam going, but I fell for it anyway, and my ordinary health insurance paid. As a result my gall stones were detected. All my results were handed back to me, so I was able to discuss them with my family doctor in my own time and in my own language, though it meant I was responsible for keeping the tests from one year to the next. I really felt I had left Greece with a clean bill of health, which is more than I can say now in the UK.
When I visited the doctor this week, I also wanted to know why the NHS only pays for mammograms every 3 years. My mother had breast cancer and knowing that the NHS calls all women over 50 for mammograms, I have been having one religiously every year, however unpleasant it is. At least when you carry the results with you, you can get a comparison quickly and be sure that they are really your results, not someone else's.
I had been reading on the internet how the 3 year interval was determined. It seems that research shows that once every 3 years is enough to protect women from the risk of dying of breast cancer. That's not much consolation to any individual who finds out that she has had cancer for nearly 3 years. My doctor admitted this. It seems that even a previous family history does not get you better treatment unless it is more than one person with the cancer and unless the onset of the cancer was pre-menopausal, which isn't the case for me. So despite this being the second most common cause of death after lung cancer, nobody cares except about preventing death. Presumably that makes the targets look bad. One could be very cynical and say that tests every 3 years gives more chance of detecting cancers than every year, so the targets are easier to meet. And what are the targets anyway these days? Certainly not number of women tested, or even equipment well utilised, or results delivered quickly.
So I decided I would go off to Lithuania for my private mammogram as it would be cheaper, in case my health insurance wouldn't pay. I can also get my hair done, and see the dentist and get some new passport photos from the man who manages such wonderful photos of everyone.
But to get back to the NHS, is there any reason why diagnostic centres can't be local, to save travelling for patients? For big really expensive equipment, it is obvious that this needs to be in big hospitals for really sick patients. But for more routine tests, equipment cannot be that expensive if they can afford it in poorer countries like Lithuania and Greece. In those countries, they just make sure it is used very intensively. And is there any need for waiting for results? Why can't they be done the same day, so they aren't left to get muddled up? Somebody should really do a time and motion study on the proper location and use of equipment. And maybe some of the small hospitals that are closing could be recycled as diagnostic centres and outpatient clinics, so that people don't have to travel so far.
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