Thursday, Jan 23, 2020
I hear a lot of complaints about the UK Health System. I hear a lot of fear from my friends in the USA too, who seem to cower in the face of what’s termed socialism. I’ve had the privilege of living in Canada, the USA, and the UK so I have more of a clue than most about the differences. I learned that paying big money for something doesn’t necessarily equal shorter waits or better care. It sometimes equals prettier decor, though.
I can’t pretend to know enough about each system but I can speak about the NHS after close to two decades here. Overall, it’s pretty wonderful. Surprised? Healthcare is never actually free, not when it’s supported by government, who in term are supported by the people – us. When you get a service that’s not funded by lots of private money, it does look different.
Many doctor’s offices and hospitals look impoverished by North American standards but that’s changing. The newer places are every bit as sparkly, advanced, and attractive as you’d expect in Canada or the USA. Systems are automated, cafes are abundant, and the biggest difference is usually the number of people waiting to be seen, even on the appointment system.
Growing up, there was no appointment system for the ‘lower classes.’ You’d show up to a crowded room and your turn would come sooner or later. You learned who was in the room when you arrived and when the last of those people left the doctor’s office, you knew you were next. Sometimes it took up your whole morning or afternoon but it was just how it was. These days if you have no appointment, you go early in the morning and wait in line, take a number or report your name to the receptionist and sooner or later, you’re seen. Mostly, though, you’ll have an appointment time.
You get your appointment by phoning in, but there’s a great online system where you can book your own, self-refer to other services (pharmacy, physio, etc) request medication, fill in some symptoms and get a phone call or email response, and some new things I haven’t discovered yet.
Since Krish has run into some serious eye problem, we have been going to Moorfields eye hospital. There are many waiting room areas and reception desks. There may be 50 or more patients waiting to see 7 doctors in each area. Things run smoothly, the doctors are skilled and personable, but a blackboard is very clear about your waiting time – it’s usually 2 or 3 hours.
Waiting times for things like tests and surgeries depend on how urgent your case is. In Toronto I didn’t wait very long for surgery. I haven’t need any in London, but for things like tests and referrals to specialists (called consultants here) the wait has been pretty short – a week to a month on average. Some very specialised things, like the sleep or the tinnitus clinic, have much longer waits. A little chat with the hospital ombudsman has usually bumped me up nicely.
At my doctor’s office, there’s a rudimentary check in machine system. You click on your arrival, you click your day and month of birth and confirm your name – the machine lets you know if your doctor is on time to see you or falling behind.
It’s a rough building and the clinic is barebones. The fanciest thing in there is the TV that shows all manner of public health service announcements in a loop. Yawn. There are three waiting areas and probably seats for at least 75 people,including a little secluded area I assume is for orthodox Jews or others who need privacy. I’ve never counted how many offices there are but there’s a receptionist window – they’re glassed in like we might attack them otherwise, and I have to say there’s never any recognition that I’ve been there before – bad! – there could be ten doctor offices and three or four nurses’ offices and off to the other side, where there’s a smaller waiting area, there’s a door leading to other offices that I’ve never been in. It’s a rabbit warren.
I waited twenty extra minutes for my doctor, even though the machine lied and said he was on time. I don’t worry about this most of the time. I know it means that somebody before me had a much bigger problem than I walked in with. I also know it means that my doctor may be a little stressed – he’s behind. In fact, this is the biggest concern for me – the appointments are just ten minutes long. It’s rarely enough. My doctor knows it but he also knows he has dozens of other ten-minute sessions to fit into his day. I’m not sure how much fun it is to be an NHS doctor. I do like this one, though, so I hold out for appointments with him even if it means a week or three’s wait. He’s tall and young, and dresses a bit carelessly, and he listens, and remembers. He’ll also try anything. When presented with something he feels is important but difficult or controversial, he lets me know that he’s presenting the situation at the weekly meeting and he’ll get back to me with the consensus opinion. This style suits me but I like my Toronto doctor who can take her time with me, knows my name and my son, has a little personal chat and a catch-up and doesn’t leave a stone unturned. Can I import her?
There are notice boards everywhere in the doctor’s office and here is where you see how socialism comes in. There are notices everywhere. This group, that club, this explanation of what your disease might entail, many community services available, and research studies to take part in. This time I find a new poster for Brocals. What’s that? If you’re a man, you can join other local men, who can be brotherly, friendly, do things with you, have a chat. Hmm.
When I first returned to London, I had to immediately get radiotherapy after breast cancer surgery. No one asked me any questions other than medical ones. I had to go for three weeks every weekday to St Barts Hospitals Radiotherapy department, at that time a very old building with very old waiting room chairs and wheelchairs and a gloomy interior. But the machinery was state of the art and the therapists were chatty and kind. I was offered cups of tea, all of my journey money refunded, transport I didn’t accept, and warm chats with a nurse from Macmillan Cancer Care. They also visited me at home, referred me to a complementary care facility where I had lovely herbal, homeopathy, and reiki treatments, all at no cost. They sent me a cheque for a new mattress and then one so that I could go on holiday after the treatment ended. The hospital environment undwhelmed, while the care and support overwhelmed. I can’t say enough for the warmth and generosity during a very difficult time. I went to groups and complementary therapy sessions for years, with free lunches, and new people to meet. I have no idea how much things may have changed but probably not all that much. I don’t like the big waiting rooms or the chance of not seeing the same doctor each time, but for bedside manner the UK has them all beat.
Maybe Brits, like others, don’t like what they have because they don’t know what it could be like otherwise. The weather, which has no real extremes, the transport system, which is huge and efficient, and the NHS, which all in all is inclusive and free.
There’s a private system. Anyone can use it without losing their NHS privileges. Some additional services are private if you need them, like my dental hygienist. Next week I’ve self-referred to a Physio clinic for an assessment. It costs £45 for a half hour session. I’ll report back.