And your problem is…?

 There’s been a lot of hoo-ha in the US press lately (and, consequently, the UK press) about the lumbering behemoth that is our NHS.

I love the NHS. I do. I really do. Irrespective of whether you’re having a mole removed or you’re fighting for your life in intensive care, the only financial aspects of your medical care you generally need to worry about are the hospital parking charges – John and I paid in excess of £150 during Harry’s 10-day stay in NICU.

But… the waiting lists. The patient care ethic. You need to be bloody patient, too, because you’re rarely treated as a customer, let alone a thinking one, the way you generally are in the US. Money, unfortunately, still indubitably equals power, in health care. There is no shortcut to quality (just fresh flowers and tv and room of your own) as the private healthcare staff are usually NHS people supplementing their income by working in an adjoining building, using (if anything) rather older equipment. Never quality. Just… power. And speed.

Harry’s physio referral was made in mid-June. In late July, I eventually had a letter from paediatric physio informing me there was a waiting list. Yesterday, I rang up to enquire politely ‘how much longer?’, as he’d been waiting 2 months. They quoted me about 3 months from his initial referral, which they claimed to have received in late July. I told them he had been referred rather earlier than that, whereupon they dumped blame on the hospital for not sending out the referral form until several weeks after the event. They were then obliged to become red-faced when I dug out my copy of the (prompt) hospital referral letter, which made it quite evident they had sat on it for a month.

Unsurprisingly, the atmos went a bit chilly after that, and I was told that late November was looking like the best they could do. I ground my teeth, and asked if anyone there did private clinics, thinking (ah-HA!) that I could have his initial assessment done privately, and by the time the NHS list caught up with us, Harry would be ready for review. 

This morning they emailed me this:

27 August 2009

 Good morning Mrs. Hairy Farmer,

 Further to our telephone conversation I enclose telephone number of a private Physiotherapist. Except, of course, she actually didn’t.

 If you should decide to go privately we will then cancel Harry’s referral to our Service and he will be punished discharged accordingly.

We know you are now caught between a financial rock and a fiscal hard place. Please let us know how you wish to proceed. We are overworked and understaffed and pissed off about it We already have a waiting list for our Service and if you do decide to burn your boats go private Harry’s place can be allocated to someone else.

 We look forward to watching you squirm hearing from you.

 Thank you.

 Physiotherapy Secretary

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26 Responses

  1. You know I’ve been reading your blog for awhile. This is most definitely a situation of you get what you pay for. Healthcare in the US is expensive, but you get it quickly and with a smile, and with viable choices if you think you are being treated unfairly. The US government has a horrible reputation of not caring about the people it serves, and I really, really, really do NOT want them involved in my decision to have my leg amputated, hysterectomy, emergency Abdominal Aorta repair, etc.

  2. Every time you are pushed aside, ignored, or sent right back to the same pediatrician who hasn’t recognized any of Harry’s symptoms so far, it just infuriates me (for you) that you don’t have access to better. The one you are assigned to seems like a complete incompetent to me, if he’s missing these things that are staring you in the face. If he’s behind on milestones, it calls for early intervention, not “Wait and See.”

  3. Actually, healthcare in the US is expensive, and you DON’T get it any quicker, with any more smiles, and with any more viable choices. If you are not employed by a huge company, and don’t have the funds to pay for everything privately, and have ever had any health problems AT ALL then you will be refused private cover and will be left with a – still EXTREMELY expensive – HMO.

    I didn’t find our HMO any more friendly or any quicker than the NHS, and we had MUCH less in the way of choice of drugs (my husband wasn’t allowed to have the insulin he can get in the UK) and referrals were slightly quicker, but just as much in the way of gatekeeping (I had to have a regular OB/GYN appointment before getting a specialist referral, and it was to an RE who does everything, not a published miscarriage specialist).

    Sure, we could have gone entirely private – but that would have cost my entire salary per month, based on one quick ER visit…

  4. (And frankly, the private sector has already screwed up US healthcare. I don’t see how the government could POSSIBLY do any worse. And no-one is stopping citizens in either country from paying for their healthcare privately… OK, I know there are “you can’t use the public service if you have gone privately” clauses, but as the physio says, there ARE a lot of other people on the waiting list)

    (Though in your position I’d be finding out who is responsible for losing your paperwork, and talking to their boss, and their boss’ boss…)

    • You’re right, I suppose it depends on what kind of benefits are offered through your employer. I’m fortunate enough to have a PPO, so I never need a referral. And I’m spoiled since I work in the medical field and know which resources are needed where and how to access them. It just makes me angry to see people being delayed/denied because there aren’t enough providers or some government non-medico is deciding what’s important for them, rather than letting them make their own decisions. And another thing. What’s to stop the doctors from seeing less than 10 patients a week, since they’re only going to make a certain salary? And how are they held accountable for mistakes? Cause they make them. More often than you know. Who polices them? Cause they need it. I’m just curious.

  5. That would make me want to go and pull someone’s hair out. I guess the benefit of US insurance is that you can get your care when you want it, if you’re willing to spend a good deal of time fighting with the insurance company over who’s going to actually pay for the treatment. In your case, I think it would be beneficial. This is where national health plans don’t work – when you do need immediate (but non-emergency) services and have to wait for them.

    It seems like they could at least do an initial consult/case review and give you some starting points to work on with Harry until they can actually get him scheduled. How frustrating.

  6. Oh now that letter is just plain RUDE!

    I think our public health system works somewhat similarly to yours. DP has been waiting for over 3yrs to see a urologist at a public hosp. Every time I ring them they claim it’ll be another 3yrs wait. For someone with a neurological disorder affecting bladder function.

  7. Just a thought. If you see a private physiotherapist, does she have to know? It’s your business. If you took Harry to an optician or a dentist, you wouldn’t have to tell her. Or do they have some Big Brother system that means she is privy to all your consultations? It’s probably the same physiotherapist, come to think of it.

    I don’t think she can be right, though. Access to the NHS has never been on a means-tested basis. The NHS is always picking up the tab for botched private cosmetic surgery, or similar. I think, knowing you are a brave person, you should return to the charge. Play the ‘he’s been on the waiting list for 2 months already’ card, and if necessary the ‘I just want to do the best for my son’ card, with a waver in the voice. No-one wants to spend their morning dealing with a weepy mother. Give her an easy way out and ask if she could check to see if there are any ‘cancellations’ (which we all know are just ways of massaging the system).

    Alternatively, get your GP onto the case. Get them to work the system for you. “There’s no point you being so efficient and speedy with referrals if …”

    • Yes, seeing a different physio on the quiet is our obvious way forward here. We were a long time getting his Paed to agree to a referral in the first place, hence I’m more impatient than I normally would be about the delay in having him assessed.

  8. Whenever I see the UK vs US healthcare debate going on, I tend to step over the anecdotal stuff these days and revert to the lovely cool unarguable empirical evidence from the statistics and comfort myself that we live longer in the UK, we have fewer neo-natal deaths, and we are better at catching diseases early and treating them small.

    The NHS may not be in pretty buildings or at your beck and call but it is *universal*, it is *free at the point of need* and it is up there at the top of the lists, and above the US, for effectiveness.

    But that said…

    What a complete and utter bitch Ms Phisio Secretary is.

  9. If you go elsewhere for physio no need for them to know and to be honest I don’t have a problem with going to the back of an nhs queue if I am jumping to the front anyway by dint of going private. Not sure I want to be a customer either as I doubt the smart room, sky tv and better food make for better treatment. As someone who is probably nigh on uninsurable in the US I will put up with a lot. Admittedly 4 mths on I am still waiting for the recurrent miscarriage referral I was promised……

  10. I worked in the states for 4 years. Healthcare was beyond expensive, most of my friends only had basic emerg coverage (as did I) as that was all I could afford. There were still things you had to wait for, and there were still doctors that were varying levels of crap to excellence.
    I was very glad when I moved home to Canada. Having lived both systems I’ll take Canada’s any day, and feel very grateful to have it.

  11. I’ve been thinking about this on and off most of the afternoon. It relates to a discussion I have fairly frequently with Mr Behn, or Dr Behn to give him his full title.

    Would you rather have excellent care delivered in a way which seems slap-dash and uncaring, or would you rather have poor care delivered by kind and devoted people? Not surprisingly, he thinks the first is preferable, but I am not so sure.

    It’s a rhetorical question by the way, but I think I’m right in saying that patients and their families are less likely to complain about negligence and incompetence kindly delivered than they are to complain about entirely correct care delivered nastily or in haste. We cut more slack for people we like.

    I’ve spent a few l thousand pounds over a couple of decades on every kind of alternative therapy from acupuncture to yogic chanting. In all that time just one single session with an osteopath made any clinical difference, but the kindness and attention left me feeling hugely better ‘in myself’. Of course there wasn’t much wrong with me apart from middle class ennui and migraines.

    On the other hand, when my father was dying of cancer his consultant was extremely brutal with me, but I needed the wake-up call, since Dad needed drugs not crystal therapy.

    This is a long rambly post, but all it is really saying is that we are not always rational around healthcare, me most definitely included.

    Oh, and Ms Physiotherapist’s Secretary is still a bitch. As my grandmother said “politeness costs nothing”.

    Aphra

    • Oh! You SPEAK to me! I have chewed repeatedly over this issue, having had, like many people, experiences on both sides of that particular fence.

      I eventually boiled it down in my own head to the fact that I want high levels of expertise, irrespective of manner, from my doctors; and high levels of care, irrespective of technique, from my nurses.

      Examples:

      I decided to return to the Very Senior & Experienced Reproductive Consultant who A) once made a fairly significant clinical error concerning my care and B) is possibly the WORST COMMUNICATOR IN EUROPE, simply because he understood more about my peculiar anatomy than anyone else, and we fundamentally believed in the chap’s abilities.

      The midwife who stitched up the damage caused by Harry’s cannonball passage made a bit of an arse of it. I now have an everlasting bloody hymen which continually tears a little, heals, tears again. Fucking ouch: it now needs minor surgery to corrrect. This woman was a bloody angel during Harry’s birth and I was enormously appreciative of her kind and genuinely caring support. I would under no circumstances consider whinging about the wonky stitching.

      • Perhaps I could have phrased that lot clearer. I would choose cold cleverness from the Dr and supportive kindness from the nurse. Which sounds frightfully 1950s, now I come to think of it.

        Of course, then you have my Obstetrician & my Radiologist, who are both decent, kind Drs and extremely entertaining men to boot. Occasionally, one can have one’s medical cake AND eat it.

    • I think your second paragraph nails it perfectly.

      It does amuse me that male gynes are always so devestatingly charming.

  12. We have very good insurance, because my husband has a good job with a large company ( Our monthly premium is $800) . But my daughter, who shares the same inherited disease that I have pays about half of her and her husbands’ income for the same very good insurance that my husband and I have. I have been in hospital 4 times this year, she has hospitalized once in her life, to have her gall bladder removed.
    They pay this for fear that one day she will not be covered at all do to her disease as the rules are clear that if you have coverage and then change insurance companies you cannot be denied coverage because of a preexisting condition. ( This is a fairly new rule and we are very grateful for it, otherwise she would not ever be insurable at all.)
    In a vast resource rich country like the United States of America our young people should not be spending half of their monthly pay on insurance premiums. They should be saving for their first house or spending it on their first baby or taking a trip to Europe.
    My mother died because she did not have health care and was too proud to seek charity care, this in one of the the richest countries in the world. Her insurance had lapsed due to a job change and she was not for eligible for Medicare until she was 65 in January . She died in August of a brain aneurysm which is very common in our disease process.
    We need to provide health coverage for our citizens, it is a right that they deserve to have.

  13. As I was dithering on and I left out my most important point, why is it that those with small amounts of power feel the need to exploit it the most? Appointment secretarys, those who schedule in 15 minute blocks of time, they feel some sort of power that the rest of us don’t. It makes them rude and bitchy, and she was really on her game wasn’t she?

  14. My middle one, who Harry reminds me so much of, had to wait months and months for an “intake appointment” with our local Children’s Hospital when he needed PT and OT, and then after that had to wait another month for a “satellite therapy office” to have space in their schedule for him. The staff was brusque and unconcerned, AND we paid through the nose via our private health insurance and co-payments. I’d take the NHS any day of the week if we had it in the US. I think the bottom line is that if you’re not perfectly healthy it’s going to suck regardless of where and what coverage you have and what you pay for it (there are degrees of suckitude, yes, oh yea verily, but suckitude it is).

  15. A great post! Just found your blog via BMB. Nice to ‘meet’ you!
    Rx

  16. We are fairly lucky here in Oz I guess … but I’m still glad we pay for private health insurance JUST so we can have the Dr of our choice.
    But speaking of dodgy messages … my daughter broke her arm at the start of the year and we opted to have an orthopaedic surgeon double check it. He was great, and so was his actual secretary …. but his wife also liked to meddle in the payment processing side as well (as we found out later).
    She rang our house twice demanding that I give her information on the whereabouts of someone who shares our last name (but whom we don’t know). The Dr’s wife wouldn’t tell me who she was or why she wanted the info so I hung up on her twice …. it was only when the Drs *real* secretary warned me I might get an odd phonecall from some woman demanding info that I twigged that the dodgy caller was the wife.

  17. I’ve been on both sides of this here game, and I’ll take the NHS, thank you very much. In fact, I’m trying to get my British citizenship despite intending to move back the the US – that way, (hopefully when we’re old and gray) if things start to go tits up healthwise and we can’t afford to stay in the US, we’ll come back here.

    The ignorance in American culture on this issue drives me mad. Comments about the NHS are bandied about by people who have no idea what the fuck they’re talking about and it makes me want to bop them on the head. Hard. I don’t see how there a country as rich as the US can’t look after its citizens to the extent that 45 MILLION people don’t have insurance. 45 goddamn million people whose country can’t even help look after their health and well-being. Tax-payers, largely hard-working, responsible people, with no options. It’s disgusting.

    Ok, rant over. Ahem. Sorry to take over there. I’m a bit sensitive about the subject , as my brother was without insurance for ages and now only has very basic cover. I’ve had doctors here in the UK with very shoddy bedside manners, but I’ve never had issue with the actual care provided. Even the GP who stated upon our start on the infertility trail, “Let’s get some tests done Mr Pru to see if you are in fact shooting blanks – hahaha!” Hurhur. That could happen anywhere though. Stupid doctors and stupid administrators are everywhere, bless ’em.

  18. Oh YES. It’s about the same here…

    g

  19. My take on American anti-NHS press is similar to how I feel about people bitching about my sisters. I am allowed to bitch about them, because I love them, appreciate them and know their faults, but Godforbid anyone from the outside having a go.

    Saying that it does infuriate me that there is no ‘topping up option’. After last months ‘green shoots’ I would happily pay for a month on clomid whilst i wait for my next IUI appointment in a couple of months time but then, like Harry I would be pushed out of the system.

    GAH!

  20. Whole NHS versus USA insurance systems already eloquently discussed above, so, am shushing my commie mouth on subject.

    But the secretary? I shall slap her.

    I still haven’t forgiven the receptionist at the Early Pregnancy Unit who was so amazingly effing rude and unkind when I was miscarrying. I wonder if I ever will.

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