Wednesday, 25 April 2007

Health care -- the English way

Everything in this country runs about as efficiently as trying to button your shirt with your toes, and that includes medical care -- at least the care you get through the National Health Service, known as the NHS. I've used both private care and NHS care, and I can tell you private care operates much more efficiently. But you basically need to use an NHS GP for your prescriptions, so I do. I have hypothyroidism, for which I have to take medication every day for the rest of my life. Which means I have to deal with the NHS.

When I first came here, I discovered that it takes literally about 7 or 8 visits to the GP to accomplish what I could have done in one visit to a doctor back in the States. And keep in mind that I have mobility issues due to knee problems, so getting around is hard for me and each visit to the doc's office required a trip there and back via cab, costing $10 plus tip EACH WAY. I don't think the problems and inefficient manner of operation I encountered were a fault of my GP's office in particular, I think that's just how things are done here. I think the basic idea here is, since the NHS is "free" (you don't pay for treatment when you go in, but you do pay a lot in taxes to fund the NHS), the feeling is that the patient has to go to a LOT of extra trouble to get the services and treatment she needs rather than the GP and his staff going to any extra trouble, no matter how small, to make things run more efficiently and prevent the patient from having to return constantly to get anything accomplished.

It worked like this: First, I had to register with a GP in whose area I live. There are several nearby; I picked the closest less than a half mile away. We had to go in and register, which meant showing proof of address (our lease) and ID (our passport). We could only do this in person, and we couldn't see the doc that same day -- that required another visit. So we made an appointment and I came back and told the doc about my need for thyroid medication. He was unfamiliar with the medication I was on (they don't sell that same brand in the UK), so asked me to go to a pharmacist and find out what the equivalent was in the UK. In the U.S., the doc would've looked it up or asked one of her staff members to call and find out, and then would've either mailed me the prescription or called it in to a pharmacy. I called a pharmacy and found out, and then called the doc's office to tell them. They said I had to come in to the office and fill out a form with the information! Hello, knee problems! Hello, if I didn't have knee problems I'd probably be working 9-5 right now and couldn't keep going into the doc's office every couple of days! Fortunately, they said it was OK if my husband came to fill out the form for me. Then, of course, they didn't have the prescription right then -- that required coming back another day to pick it up.

But the visits were far from over. I also had to make a separate appointment with one of the GP's nurses to take my medical history. They do not give you a form to fill out on your first visit with the doc like practices in the U.S. do -- you have to talk to the nurse (I assume because they think she'll fill out the form more accurately, though she didn't with my husband -- he noticed that when he told her he quit smoking 12 years ago, she wrote down that he had smoked for 12 years). And of course you don't get to see the nurse on the same day you visit the doc -- you have to come back for that.

So I came back, paying another $20 in roundtrip cab fare. And because of my thyroid condition, they needed to do a blood test, which the nurse there could've done. But after hearing the history of high blood pressure and cholesterol in my family, she wanted me to do a fasting blood test. This even though I had had my annual exam four months earlier and had all the results to show her -- she felt four months was a long time ago and I needed to be rechecked. Because the test had to be fasting, I had to go in on another day, this time to the hospital. Another $20 in cab fare later, I got tests. I was told to call the doctor's office in X amount of days for the results. When I called, they told me I needed to come in and see the doc! In I came, yet again, and was told my cholesterol was a little high. That was it. He said he wasn't telling me anything particular I should do about it, just that it was a little high and that I should come back in three months for another blood test! In the U.S., the doc would've either mailed me that info in a letter or else called me himself (or had a staff member do it) to tell me. But not here. Here it's perfectly reasonable to expect the patient to return needlessly, even when you see she can barely walk. Again, I'm not trying to pick on my GP's office, I think they are just doing things the way they have always been done and that it seems perfectly reasonable from their perspective.

What sparked my rant down memory lane was that I was going to send my husband to Boots (a drugstore) to refill my prescription today. This was the first time we'd refilled medication in the UK. We weren't sure how to do it, because the containers the pills came in didn't state the number of refills left, and we had a slip that the pharmacist had torn off of our prescription and handed back to us that said we had 5 refills left. I thought we took that slip back to the drugstore, but my husband thought we took it back to the doctor for another prescription. I was sure he was wrong, as that's amazingly inefficient and a waste of time for us, the doctor and his staff. So of course it turned out the inefficient way is what we have to do! My husband brought the slips for both of our medications back to the doc's today, and in two days he can pick up a new prescription. Boots does have a service where you can request them to pick up the prescription for you (if it's to one of the doctor's offices that they regularly make pick-ups from). I had thought that meant they'd get a new prescription for you when you run out of refills, but now I see they mean it's a monthly task for people who have remaining refills.

It's a crazy-ass country.

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