Socialised Medicine...

As I posted before, I had an accident when I was away in Canada on holiday. As an American living in the UK, I had always been stigmatised since I was young that “socialised medicine” was a bad thing, so it was with a bit of trepidation that upon my return to the UK I was going to have to jump into it with both feet.

A lot of the media in the UK spend time picking at the NHS, debating ad nauseum things like the “post code lottery”, the super bug, management overhead and waste and pretty much anything. I think the vast majority of it comes from debating any large government institution. It will always have the good and the bad. I did note, that during the US debate on healthcare reform, the Republicans had found one Conservative politician who they propped up to rubbish the NHS system and scare the general American populace, but everyone quickly backed away from him and made statements like “while we want to improve it we wouldn’t give it up for anything.” That generally happens with my conversations with others in the UK, while they will have a whinge, there is no way they would give it up. I thought maybe this was just out of ignorance, not knowing how great a “free capital market” is, which had been drummed into me in my years in the US.

Well, I have to admit, I think I had it wrong. My experience, at almost every turn, outstripped my private health care in the US at every turn. I will admit it does seem a bit bureaucratic and process driven and the number of times I heard “I will fax them” which made me giggle, because the whole of the NHS seems to work off late 80′s technology at times.

The first hurdle was registering with a GP (General Practitioner) which is the gatekeeper to all health services. While I had been in the UK for 5 years, I had never needed a GP. So I simply didn’t exist in the eyes of the NHS. GPs are geographically bound, and much like in the states with HMOs, my local GP was actually a large practice of GPs that generally shared the workload. While building a relationship with a particular GP is great, I was actually quite happy to get a big practice. So I called them up when I landed back in the UK to try to get an appointment. This I found out was going to be my first and last challenge. They first told me they could see me on Wednesday at the earliest but when they found out I wasn’t registered, I was quickly told I had to come in and register first before getting an appointment.

I figured I would just show up at the practice on Monday and argue my case, because my injuries were rather obvious and I thought, worst case I could just sit in the office until they saw me. I showed up at 8AM, explained my situation and while they got caught up in their process briefly, I essentially walked away with an appointment at 9AM to see a doctor. That was the end of my “challenges”. I filled out some paperwork, brought it back at 9 and at 9:07AM I found myself sitting across from my GP. No nurse bringing me into a room and then waiting another 20 minutes to see the doctor for 5 minute . s, I spent a good 35-40 minutes talking to the doctor, in her office. We went through my whole medical history and she suggested some other things that she would like to help me with on top of my immediate need.

I was all prepared to invoke “private medical” insurance, which in the UK means that your GP, instead of referring you to an NHS specialist, will refer you to a private doctor, where waiting times are known to be significantly less. I am lucky that my employer allows for that option. So I was thinking that I would have to wait weeks to see someone in the NHS, but the opinion that I have come to is that it is really a needs basis. If it is urgent you see someone, you see someone, if it won’t get any worse (and likely cost more to fix, let’s be practical) then you see someone right away. Also, I think I was a bit luckier than most in that at St. John’s Hospital in Livingston is the UK’s specialist team in facial surgery (the maxillo facial team). So when I told the GP I had private, she said “well, let me see if I can get you in to Max Fac folks and if you aren’t happy we can pursue the private”.

She called me back later on Monday and said “I have you in at 9AM on Wednesday, does that work?” and I was elated and falling deeper into the rabbit hole of the NHS. I showed up at St. John’s hospital, and I will admit, it is vast and confusing and trying to find the right department was a bit daunting, but what hospital isn’t? One thing I do notice is in a very British way, they know how to wait. Someone might get the impression that the NHS isn’t much more than a rabbit warren of waiting areas, all brightly lit, with lots of signs about what to do and not do and government posters about their performance targets.

About 09:20 I got called into a consulting room by a doctor. Again, a 20 minute wait post appointment would be of little of surprise, but I got an apology from the doctor (again, a doctor, not a nurse). He was one of the junior doctors in the department and went over my injury and got my medical background (because I wasn’t quite yet “in the system” fully) and then looked at the scans I brought back from Canada. After that he went to go talk to his consulting doctor, and then the two of them came back in, talked to me a bit more and explained quite a lot about my injury. Two doctors, in the room, at the same time!!!! I spent about 45 minutes in total talking to doctors. They then arranged an appointment on Thursday to have my eyes checked just to make sure 100% that there was no problems with my vision and arranged to meet me the following Wednesday to hopefully wrap everything up, telling me it was unlikely that I would require surgery, but they wanted to do some additional analysis of my scans.

So, Thursday, another trip to another totally different part of the hospital, another set of waiting areas and again a total apology for calling me 10 minutes late for my appointment. This time I met a nurse, who ran me through the exams and tests, as kind and pleasant as you could ever expect. Also good news in that my eyesight is fine.

So I total, I have seen 3 doctors, 1 nurse and in a matter of 4 days had a full assessment of my injury. I filled out two sheets of paper at the very start, but since then, I haven’t had to fill out one sheet of paper at all. Everything else has been taken care of. I am also lucky in that in Scotland, prescriptions are also free of charges.

So all in all, my experience with socialised medicine turned out exceeding my expectations and in a lot of ways exceeded what I had come to expect from especially HMOs in the US. The best thing is the comfort in knowing, no matter what, that you will be taken care of. That peace of mind is very very comforting, especially when you do something daft, like fall off a bike.