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PT and the Greater Good

Being a Service User in the NHS

Published January 13, 2010 2:54 PM by Dean Metz
On Friday, I had my first appointment with the surgery (office) of the doctors in my neighborhood who are accepting new patients. The system is not unlike that of an HMO in the states. There are lists of practices from which you can choose your GP (PCP). In the UK, however, the practices you can choose from are based upon your residential postcode, whereas in the USA your choices are based upon who participates with your plan. I had called two weeks prior to make this non-emergent appointment. That is approximately the same period of time I would have had to wait for a similar appointment in New York.

I arrived a half hour early to the office which was clean, was greeted by staff who were friendly, and was seen by the nurse practitioner within 10 minutes. I answered a series of health screening questions and had my vital signs taken. The NP asked if I had any concerns which I thought needed immediate attention of a physician, as there was one of the staff physicians in the office. I replied that, no, I didn't have any immediate needs other than to refill my Lipitor prescription. I've taken this medication for over five years and my doctor in New York provided me with a prescription before I left to show to my UK doctor. The NP left the room and three minutes later provided me with a UK prescription for Lipitor. I was instructed to stop back in a month so that they could run my bloods for a baseline value. She would've taken them immediately but I foolishly had miscounted my remaining pills from the US and ran out about 3 weeks ago. She wanted my bloods when I had my usual meds in my system. Made sense to me! I was instructed that I could call the surgery before 8:00 am and get a same day appointment. The offices purposely save time slots for people calling for same day needs. My New York doctor didn't do that! I left the office a mere 30 minutes after I had arrived. Total out of pocket expense; nothing.

I then went to my local pharmacy and presented my prescription for 2 months worth of Lipitor. Total out of pocket expense; 7.20 pounds sterling ($11.50 USD).

Back in the states I had what was considered to be good insurance plan through my employer. The same process though would've cost me $25.00 co-pay at the doctor's office, and $25.00 co-pay per month's worth of Lipitor for a total of $75.00 USD.

I've heard all the horror stories about the NHS but, I'm sorry, I'm just not seeing it.

I made a house call today to a patient with an asthma exacerbation. It was a joint visit with a nurse. I provided chest PT and she reviewed the patient's medications, which included nebulizers and steroids. The patient simply wasn't improving so we called the MD. The MD listened and responded, "How about if I go and see the patient during my lunch?" Nobody blinked an eye except for me. It is normal for a physician to stop and do what is needed for a patient here.

I had been very nervous about the quality of care when I moved here. I'm not nervous anymore.

5 comments

Dean,

We have some friends who moved to Ireland about 9 months ago.  We have other friends who lived in Italy (he was actually born there).  Both couples talk about how different the lifestyle is...how much more laid back life is and how much of an adjustment that is.  The one friend ran a plant in Italy...was sent over to Americanize it.  He said the two hour lunches took some getting used to!  

My husbands parents have been to Ireland and Poland several times.  They talk about how lengthy meals are and in Poland they have their afternoon tea with pastry daily.  Living is a way of life.  Working, not so much!  Europeans seems to have a completely different midset when it comes to quality of life.

You definitely have a point about the hecticness of having to work through lunch compromising your decision making abilities.  I've been to the doctor before when I could tell he was overwhelmed by the way the day has gone.  Doctors are human.  Rest and nourishment can only be positives.

The question about people coming to the US for treatment is something that is stuck in my mind's recorder.  You know those things that you hear over and over, but you can't remember where.  But when certain conversations come up, those comments pop to the mind's forefront.  Usually I just blink it away, but since I had someone who might be privy to actual factual info, I thought I'd let it go ahead and materialize.

It makes sense that New York City would be one of the main cities to receive an influx of foreigners for medical treatment  It also makes sense that the question I quoted could be something that was an issue years ago, but isn't anymore and yet people keep recirculating it...kind of like those prayer request emails that began as legitimate 2 years ago, but now the person is either dead or healed.  Or the virus warning emails that were legit 3 years ago, but aren't currently active.  Yet those emails still end up in our inboxes.  So, just like I hit delete on the email hoaxes, I'll delete this question/statement from my memory files!  Thanks for arming me with actual facts.  Those are always cool to have.

Janey Goude January 26, 2010 12:29 AM

Janey, Thanks for taking the time to read my post. You bring a lot of interesting questions to the table. Doctors here are paid by salary. They are paid well, but not exorbitantly. Lunch is a non-negotiable issue here. That is something that I've had to get used to. There is a value to quality of life that nobody is willing to give up. I rather like the idea. My MD in NYC was fantastic, but always exhausted from overbooking of patients and never taking a lunch. That can't make for good decision making.

I've yet to meet anyone whose flown to the USA for treatment from the UK. Either in my experiences here in the UK or from when I was working in NYC. Are there numbers to support that statement? Where did you hear that from? That may have been true in the late 70's and 80's when there was a long wait for things like joint replacements, but it is not true anymore. Seriously, I would like to know where you got that information from.

In my studies of public health, we are discussing what "adequate" care means. There will always be a certain financially able group who will do whatever is necessary to obtain care that they deem necessary, but that the rest of the medical community may decide is elective or experimental. That doesn't mean that they are not being provided with adequate care.

I have heard stories of the faults in the care here, but they are all from over 20 years ago.

Dean Metz January 25, 2010 6:13 PM

Dean,

Thanks for sharing this experience.  

My doctor's office does leave some appts open for "same day" call-ins, but they fill up quickly, especially during flu season.  The nurse makes the call as to who gets the slots and who can wait until the next day.  I'm not sure if the definition of "leave open" is the same here in the states as it is there in UK.  As an established patient, I usually haven't made it to the treatment room in 30 minutes, let alone seen the care provider :-)

The speed with which you were provided care (as a new patient) is commendable, as is the doctor who is making the house call at lunch.  My doctor couldn't do that because he doesn't get a lunch break...he works straight through until, 6 or 7 some nights.  My mom's doctor in another state actually gave her an appt time of 7pm.

For care to have been dispensed so quickly to a new patient, my guess is they weren't booking 2-4 patients every 15 minutes as they do here.  For the doctor to have had an open lunch to have the time to go see a patient, he couldn't have been way behind from all his scheduled appts showing up that morning.  I'm curious what the doctor's typical patient load is like.  

I'm also wondering what their compensation is.  My personal opinion is that greed fuels many of the medical decisions in our country.  That is why the US doctor's patient load is so high, why you wait so long, why doctors don't have time for house calls, why a lot of things.  

My hypothesis:  US greed is not compatible to the system you've described in this post.

To be fair to both sides, I am also curious of your take on the often asked question, "If their system of healthcare is so superior, why are their citizens flying to the US for treatment?"  If the relatively routine care you received at a different level from more advanced medical situations?

Janey Goude January 24, 2010 1:05 AM

Dean,

It is nice to hear the positive side from you first hand.  Perhaps someday that same system will replace the one we have in the U.S.

It would be nice to have a local MD make a house call rather than get up, get dressed and wait over an hour in an a plastic chair waiting room.  This is especially benefical to the elderly who have to drive themselves and may be over or under medicated and pose a risk for others on the road ways.

Jason January 17, 2010 7:48 PM

I really have enjoyed reading this.  I am not naive enough to think any health care system is going to be all things to all people.  But having worked in a hospital, and in nursing homes, all I know is what I am seeing here doesn't seem to serve those I see very well. There are new restrictions on Acute Rehab here that just seem to push the fact that Medicare funds rehabs, but with so many restrictions and as providers the hoops we jump through get more restrictive and frankly keep us from the patients.   I have family in Norway and they have had good experiences with health care provided there. And England's system has been demonized by some in the US, so it is interesting to see your first hand experiences.

Katesel strimbeck, PT - PT Supervisor, st. Peter's Hospital January 16, 2010 7:53 AM
Glenmont NY

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About this Blog


    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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