As described in the last post, the NHS in England has been underfunded since at least 2010 . But what kind of state is it in from the patient's point of view? Well, let me tell you about my own experience. As described in an earlier post, the air quality in London is legendarily bad. Contrary to what some of our acquaintances said, my health problems due to air pollution did not disappear over time (burning bronchial tubes, fatigue...). Perhaps there was more to it than just sensitivity to air pollution? To investigate the question, I tried to make an appointment at a GP practice.
My first contact with the NHS was overwhelmingly positive! However, my assessment was strongly influenced by my experience in the Netherlands where I lived the years before. Dutch doctors appear to keep busy mainly by avoiding seeing and treating patients.
If I reported to a Dutch GP, I was first asked if I was bleeding or had a fever, which was usually not the case. If not, they told me to wait a few days, perhaps my symptoms would just go away. A halfway understandable measure. The human body can deal with most of the common medical problems itself (viruses etc). But even in the case of bleeding or fever, after a brief hesitation, I was asked to wait a few more days before seeing a doctor. (Just for clarification: All this was pre-pandemic).
In Great Britain, on the other hand, the first attempt to get an appointment was crowned with success. And the doctor listened to me, seriously considered how my symptoms could be explained and ordered a blood test, which I got some days later in another surgery... And that was the end of the good experience.
I waited for a response in vain. My wife, a GP herself, told me the lack of communication was not unusual. If results are regular, patients might not get informed anymore, due to the overwhelmed system. But the administration is also more or less incompetent - Lab results often get lost somewhere along the way or they forget to make follow-up appointments, even if they are needed.
It took several weeks before I got a second appointment. And as my wife predicted, only after I called to check if my results had arrived.
The second appointment was with a different GP. In the UK, GP surgeries are much larger than in Germany, often with a several doctors dealing with patients. Different employment schemes also contribute to a regular turnover of doctors. There are regular permanent employed GPs and freelancers, so-called locums.
The locum system is not a bad idea. If one of the regular GPs is absent, whether due to illness, vacation or parental leave, a freelancer can take over his or her shifts. In London, however, locum doctors are a normal part of the regular GP workforce. Many positions are permanently filled by rotating freelancers. Why do they avoid a secure permanent position? Working hours are more flexible and the per hour net income can almost double, due to higher wage in the first place and possible different taxation.
If you've ever heard of German doctors jetting to the UK on weekends to earn as much as they do in Germany during the week with just a few hours of work, they're working as locums.
Why am I telling them all this? In short, all the GPs I encountered in the following months, were locum doctors and I only saw them once. Naturally, no one was familiar with me or my problem. They had my medical record in front of them, of course, but that is no substitute for patient contact.
Anyway, GP number two told me my blood results were fantastic. He sent me for an X-ray, which was done a few weeks later at a hospital. More weeks passed before I found out about the results.
GP number three was impressed by my perfect X-ray lungs, but wondered about the actions of his predecessors. For him, the diagnosis was clear:
It burns when you ride the subway?
Yes.
Where?
About here and here.
Ah, heartburn!
What?!
HEARTBURN! I prescribe acid blockers and we'll see if it gets better in a few weeks.
???
Goodbye.
GP number four was rightly confused about GP number three's diagnosis. In addition, in her eyes my blood values were not as great as GP number two thought. However, the examination had taken place some time ago, and further steps were to be discussed after a second blood analysis.
Weeks later, after many phone calls, I sat across GP number five. In his eyes, my blood results were great again. Because of the burning, maybe I should see an ear nose and throat doctor, he will refer me. Of course, several weeks passed until the appointment. And I had to travel through half of London. Ear, nose and throat doctors are usually located at a hospital. (In Germany I would just visit one at their surgery, wherever I want, in the next days… or even on the day)
The specialist immediately identified me as German and told me about his time as an army doctor in the North of my home country. He also checked my throat, but the examination did not take even a second. At least, he was the first doctor to do an examination himself.
The specialist diagnosed an irritation of the throat and directly suspected that I lived relatively close to the city centre. The type of irritation was typical of Londoners, he said, and advised moving further out of the city. Then he laughed and added it would be best to move to Germany, where it would be much nicer. He could not do anything else for me, the remaining symptoms were mysterious to him. He recommended a referral to a neurologist.
For a change, the NHS information system worked. Within two weeks, a letter arrived confirming an appointment. However, the wait was eight months. At the appointment I spoke to an exceptionally friendly doctor. On the phone, not in the hospital, after all, we were in the first lockdown of the pandemic. The second specialist not only listened to me carefully and asked detailed questions, but also told me enthusiastically about her German relatives. Apart from that, she suspected I had a rare allergy. She would send a letter to my GP surgery, recommending an appropriate referral.
She also said I might be lucky. Because of the pandemic, the healthcare system was beyond capacity in many areas, but in some the opposite was true. Maybe I would get an appointment in two months instead of having to wait the usual six.
She was not at all wrong about the two months, at least it took that long to get the copy of her report. Unfortunately, no letter arrived at my GP surgery, or it was lost there. Again, phone calls followed, but I waited in vain for a referral until we left the country.
I can summarize my experience with the NHS as follows: A lot of letters, a lot of bureaucracy in general, a lot of effort on my part, but little to no benefit. Just as one can expect form an organization formed after socialist ideals, see the origin of the NHS. It revolves mainly around itself.
By the way, in between, I visited my parents in Germany. When I told them about my ongoing problems, my mother immediately made an appointment with her ear nose and throat doctor. Two days later the doctor checked my throat. In the short time I was in Germany she could only diagnose the same irritation as her counterpart in the UK. However, she prescribed something to alleviate the irritation. A mixture to inhale and soothe the tissue, as well as tablets to protect the throat. And what can I say, the meds helped immensely. Was that so hard?
With all my stories, you are welcome to remain skeptical. Is the system really as inefficient as described? The employees so incompetent? Maybe I just ended up with an extremely poorly run surgery or had to deal with a cultural barrier, despite the support of my wife .
Well, maybe my GP surgery was indeed more badly organized than others, but on the whole the picture is correct, as a few more examples illustrate. Shortly after my move, my wife struggled with a persistent respiratory infection. For weeks, she spewed yellowish-green mucus.
Colleagues prescribed antibiotics, but they didn't help. An X-ray also did not lead to a clear diagnosis. The whole procedure took weeks (again). Finally, she was referred to the hospital for a CT scan. My wife did not want to wait until the scan and vehemently asked for other antibiotics. After a long battle, which she could only win because she is a GP herself, she got them. The new ones worked miracles, her symptoms disappeared almost immediately.
And the CT? Six months later, she received a letter with the promised appointment, which was scheduled another month later. She tried to cancel it, but that didn't work. To avoid any major upsets, she showed up for the scan.
Fortunately, my wife did not suffer any permanent damage due to the delays. This time. A few years ago, on the other hand, she injured her knee while playing sports. A harmless injury, if she had been treated directly. But both, diagnosis and therapy, were delayed by weeks. And when the latter began, the tissue was already scarred.
In everyday life, the damage does not cause any major problems. I would almost say the opposite is the case. After a few hours of shopping, the knee forces to stop the tour, with a positive effect on her wallet.
But my better half used to be a passionate dancer and loved to hike in the mountains. Today we can only pursue her hobbies to a very limited extent. Because of a completely unnecessary delay in treatment.
My wife is not alone with her problem. If one walks through London with open eyes, one will notice the high proportion of pedestrians with walking problems, people in all age groups are limping... I don't even want to imagine what consequences the delays have for other medical conditions.
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