Healthcare, compare and contrast
An article in the BBC News described a potential new insomnia treatment on the National Health service, a $25 computer course, instead of seeing a doctor. When I was 16 or 17, I saw my local NHS doctor because I was tired all the time and had crappy sleep. He prescribed iron pills for anemia (which he didn't test for), and told me to relax. I never went back. My sleep never got better, and I just tried to deal with it.
Now I'm in America. I still have insomnia, and it's bad enough that I've had to take time off work because of it. I saw a doctor at the sleep centre in St Louis on Monday. We talked, and that Friday I did an overnight sleep study. The following Monday I got two calls from the sleep centre about my results, one from a technician and one from the doctor, who prescribed one of the drugs we'd talked about. That Wednesday I picked up an actigraph for a week-long study. When I returned it the following Thursday I saw a cognitive therapist for an hour, who used the actigraph results to suggest some treatment. I have a follow up appointment with the doctor in three weeks time, and with the cognitive therapist in seven weeks time. Both have provided incredibly useful information. I've made some changes based on their advice, and I'm sleeping a lot better. I'm not tired all the time.
Contrast that with the story of someone who commented on the article who is being treated at the Edinburgh sleep centre. She saw a doctor 13 months ago, in July 2008. Her sleep study was in April 2009, and she'll get the results in November 2009. That's a total of 16 months for what I got in a week and a half, and she's grateful to have even been seen. I got an appointment two weeks after I called because of a cancellation, otherwise it would have been about four weeks. This is the side by side comparison:
| US Healthcare | UK Healthcare | ||
|---|---|---|---|
| Day 1 | Initial doctor visit | Day 1 | Initial doctor visit |
| Day 5 | Overnight sleep study | ||
| Day 8 | Results of sleep study, Prescription from doctor |
||
| Day 10 | Start of actigraph study | ||
| Day 18 | End of actigraph study, Visit with cognitive therapist |
||
| Day 45 | Follow up visit with doctor | ||
| Day 73 | Follow up visit with cognitive therapist | ||
| Day 273 | Overnight sleep study | ||
| Day 487 | Results of sleep study | ||
We're lucky in St Louis to have the Washington University School of Medicine. There's a lot of good doctors in town, several large hospitals, and a lot of medical students. Hubby and I are also lucky to have good health insurance available through both our jobs. But even a part-time job at McDonalds or Starbucks comes with health insurance.
Another BBC News article described the lack of domiciliary care in NHS hospitals. 2% of patients describe their care as poor, a figure which hasn't changed in six years and represents thousands of patients. The article describes patients being left lying in their own waste, given food and drink they can't open. A follow up article has more examples of NHS lack of care. The explanations from the NHS on each case are telling.
When my grandmother had a stroke, we had to go up and feed her every day because the nurses didn't have time and she couldn't feed herself because she had Parkinson's Disease. I wrote the date in the dust on the windowsill the first day, and it stayed there the whole time she was in hospital.
Another BBC News article says the NHS is heading towards online cognitive behavioural therapy for depression. One huge problem in depression is a tendency to isolate, getting out of the house and to an appointment is therapeutic of itself. Also, a therapist goes on more than just typed words. Posture, tone of voice, expression, gestures, none of that is available in the kind of chat sessions the NHS is advocating. But online CBT is cheaper than a face to face appointment, and it seems that is all that matters to the NHS. They needed an extra 10,000 therapists in 2007. By 2011, they will have 3600 more, less the ones that retired or quit in those four years.
Britain has a much higher incidence of continuous deep sedation than countries that allow euthanasia, one in six deaths involve sedation. That suggests it may be used as a legal alternative to killing someone. A doctor in the article says deep sedation is required only "very uncommonly indeed". Nearly 17% of deaths is not uncommon at all.
A friend in America had a heart problem where there are too many electrical connections to the heart so it beats irregularly. She had to wait two weeks for the corrective operation because she was pregnant and they wanted the baby's lungs to finish developing. Baby and mother are fine now, she had a c-section and the heart operation within days of each other. My sister-in-law had the same heart problem. The NHS Hospital put it off repeatedly because the condition wasn't life-threatening. Eighteen months after the problem was identified, she was treated with the same operation my friend got in two weeks. Because of the delay, fluid built up in my sister-in-laws' muscles, making it hard for her to walk. The extra weight she gained gave her a hernia, which the NHS won't operate on because she's too heavy. So they just give her morphine. She's in a wheelchair now, and likely will not work again. When I first met her, she was working as a nurse in a facility for adults with mental problems.
The author Terry Pratchett is paying for his own Alzheimer's drugs because it's not on the NHS-approved list of medications for someone his age, even though it is effective for his condition. Most people can't afford to pay for the drugs they need when the NHS decides they can't have it.
I'm well aware the American system of healthcare isn't perfect. But people trumpeting the NHS as the cure for America are ignoring the sometimes appalling standards of "care" rationed out. The standard of care I've received in the US is excellent. The care I got from the NHS was horrible. My gut reaction is to avoid doctors because I expect to get fobbed off with the "just deal with it" response that I've got over and over again from the NHS. That's why private health insurance is a huge perk on some UK jobs.
If the British National Health Service was as good as it's claimed to be, there would be no private health insurance companies in the UK, and no private wards in hospitals. There are plenty of both.
Edited to add (21st September 2009)
Article in the Telegraph: One in six NHS patients 'misdiagnosed'.