A Tale of Two Systems

My family doesn’t like to bother the doctor. We behave as if seeing patients is the last thing a doctor would want to do (which perhaps it often is), not actually his job or his duty. Even when we lived next door to our GP in a small Wiltshire village in the 1970s my mother was loth to trouble him, with the consequence that my then 15-year-old brother nearly died of a ruptured appendix. It got to the point where he began to have out-of-body experiences (he could probably have visited the doctor astrally whilst the doctor was having his breakfast just fifty yards away) before, with some reluctance, the doctor was called, followed in short succession by the emergency services. Fortunately, he survived.

These self-denying notions were reinforced by a style of schooling that regarded sickness as a moral failure. You just had to get on with things, come what may. You played cricket, or swam, whatever the weather, as long as you could stand. With sufficient stoicism you might even survive death.

Whether I’ve inherited the feeling or acquired it, I’m still reluctant to visit the doctor unless I’m almost at the point of physical collapse.

emergency

Over the last two years I’ve twice been near this point, first during a business trip to Atlanta, and second, just two weeks ago in London – sinusitis (painful but hardly life threatening) in the first case, and a very bad cough (imagine the last act of La Traviata) in the second. I had a flight to catch in Atlanta, and Christmas to get through in the UK, both daunting and arduous experiences requiring considerable mental and physical strength.

What do you do when you’re sick in a foreign land? Although I’m British I’ve lived for nearly thirty years in Central Europe and am no longer familiar with the way the National Health Service (NHS) works, nor eligible to use its services. And on whose mercy do you throw yourself in the United States?

In Atlanta I was staying in a vast conference hotel, and on check-out morning I felt so incapable of boarding the London flight that I called down to Reception under the old-fashioned impression that the hotel might offer some sympathetic advice or even a ‘house doctor’. The hotel had more than a thousand rooms, surely enough to keep any doctor busy. Reception, however, was at a loss, indeed surprised to be troubled with my medical anxieties, but the nice lady at the end of the line wasn’t entirely unhelpful.

‘On a Sunday, the only thing you can actually do is to go to Emergency Admissions at Emerson Hospital.’

This seemed somewhat dramatic. Surely , if you can get to Emergency Admissions at a hospital on your own two feet, you don’t really belong there. I could certainly walk, and wasn’t visibly in need of first aid. If I were to appear un-stretchered at Emerson Hospital, wouldn’t I face scorn and contempt for wasting the time of busy doctors and nurses? They would surely be frantic, doing heroic things such as saving the lives of fat men having heart attacks. But I went.

The details aren’t all that interesting. The taxi actually took me to the wrong place – paediatric admissions – and I spent half an hour just filling out forms releasing this part of the hospital from the legal responsibility of letting me leave. And at the right place, after I’d seen a triage nurse in a reception area as elegant as a five-star hotel, I spent the first half hour trying to prove that I could pay for whatever treatment they had in mind for me (I had to give the name and address of my American colleague Barbara so that they had someone to chase in case my credit card payments bounced).

Then I saw a nurse and a doctor, received intravenous fluids, antibiotics, this and that, was patched up and sent to the airport. A doctor talked to me of his respect for our Queen. It took 90 minutes and cost a staggering 1,800 USD (which, very fortunately, my insurer paid without demur).

I wouldn’t call that a system fit for purpose – or not at least the purposes of a foreign visitor. It was difficult to find, expensive, bureaucratic and overly cautious.

Compare that with the NHS. When I’m in London I stay at a flat I call the Cave (it’s partially submerged and the low winter light of London doesn’t usually reach its inner spaces). There’s an NHS clinic around the corner, but they explained that they won’t see unregistered patients, neither stretchered nor un-stretchered. So, a short taxi ride away, I visited an Urgent Care Centre, which was part of a small hospital. An Urgent Care Centre isn’t as parochial as a Clinic but neither is it as dramatic as Emergency Admissions.

I explained to the nice man at Reception that I wasn’t in fact eligible for any kind of treatment and would gladly pay. He asked me my name, and to my huge astonishment he found me in the NHS database. I’m a database systems designer and I know how hard it must be to set up a nationwide database of around 60 million potential patients. My last contact with the NHS had been more than thirty years earlier, and yet they had collected me into their system from somewhere.

A triage nurse saw me immediately. Did I catch a glint of contempt in the way he looked at me? Twenty minutes later I was examined by a nurse practitioner. Clearly no need to waste the time of a doctor. The nurse, who was perfectly familiar with the third act of La Traviata, was sympathetic, but said there was nothing anyone could do about viral bronchitis.

So, you see, my school was right. You just have to get through these things. No wasteful prescriptions of precautionary antibiotics, either.

‘And don’t bother with cough syrups, they’re a complete waste of time,’ he said.

And there was nothing to pay.

‘If your HNS number comes up in the system,’ the Receptionist said as I offered him money, ‘then you don’t have to pay.’

The NHS is impressively fit for purpose. I was astonished by its IT systems, its efficiency, its honesty and realism. It must surely fail from time to time, but what human institution doesn’t? When I compare this London experience with the Atlanta one, I’m in no doubt about where I’d rather be ill

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