I've spent today nursing a mild cold but yesterday spend half the morning in hospital. They had an ebola scare last week and there were "latest infection alert status" posters all over; I'd started a slight cough on Sunday but I was not worried. So why was I there?
Well it all started at the end of July when I popped into my GP's surgery to check on a couple of things, really just for re-assurance but then we hypochondriacs get ill too. No, the little bumps and the itchy spot on my back are not cancerous but the other worry needed a bit more investigation. I'd become increasingly aware of occasions when I temporarily forgot a word. I could define it and give synonyms but it was a bit like having dictionary with the word blanked out. My mother likely had transient ischaemic attacks between one stroke and her final, fatal one. So my concerns were not completely unfounded.
First stage though were a full range of blood tests which needed me to starve for 12 hours before the samples were taken. The surgery's nurse practitioner took them a week or so later and a couple of weeks after the results were back. All clear and a bit of a surprise for the GP that my lipids were fine. So I thought the next stage would be a CAT scan to see if there were any problems. A bit of a worry for me then that she referred me to the hospital's memory clinic. Still, as my step-father died of Alzheimer's (due to very low blood pressure!) I thought if I was starting to go doolally, at least they could track progress and I could make appropriate arrangements as and when necessary.
So in due course a large envelope thumped onto my doormat from the Clinic. Along with details of the appointment were strict instructions for my "carer" or a friend to accompany me and three questionnaires. The reason for taking them became obvious when I went through the questions for "me and my carer" which came along with one to assess my mood and one for the "carer" to let them know if he or she could cope with looking after me (!). One of these asked if I was about spacial awareness and if I could get around on my own (0 points) or needed to be escorted to the bathroom because I forget where it is (4 points). Still, I showed good will and dutifully filled it in - I even noticed they had photocopied the last two pages twice - was this a test???? The friend I sometimes dog sit for agreed to babysit me. Rather ironically I had to remind him about it on Sunday night.
The wee hours of Monday morning were not good. Not only was I having to not eat for 9 hours (WHY?), the start of the cold and nerves kept me awake. It did not help that I had to leave at an ungodly hour to meet up at 8.30 for the first appointment at 8.45, nor that I could only find the jar of decaffinated coffee. As usual both of us overestimated how long the journey would take so we were both there by 8.20. We agreed as the first item on the agenda was the CT scan, he'd go up to the cafe and work on his signing for the deaf course homework. We'd meet up later. Here's where the question about getting around became relevant. The radiography department was on "1st floor, Yellow zone" and the cafe "1st floor, Green zone" but somewhat confusingly no location was given for the ECG which I also had to take the results of to the clinic.
Luckily the nice woman at the Radiology reception pointed me to the ECG unit, just round the corner and booked me in for the CT. Next challenge for the confused was what do you do when you get to the ECG unit before they open and a notice directs you to go to their reception "through the door". Only problem, the door's locked. Good thing they have a buzzer hidden on the wall. I was a bit concerned about whether they would get it done in time but I called a couple of minutes after they opened. The ECG technician let me take the last few sticky pads off, he'd caught a hair putting one on and was trying to be a bit too gentle taking them off. Back to Radiology for my 8.45 appointment. Outrageously I had to wait until 8.49 to be called in. Then they tried to confuse me by telling me the results would be sent to my doctor in a week or so - they meant my GP but the Clinic can access them immediately.
After that, the Clinic appointment was 9.30 so I had enough time to get a cup of coffee although it was a good thing I can take hot liquids! I had also been asked to take any meds with me so it also gave me an opportunity to copy the list from my phone. I have my blood pressure drugs listed on my phone app so I can request a repeat prescription. I had intended to just show it at the Clinic but realized that parts of the hospital had no signal. Still, feeling a little smug I'd taken that into account I set off for the clinic in the Pink zone. My friend seemed to be happy to stay in the cafe on standby in case he was needed.
The Pink zone turned out to be next to the Green zone and I got there betimes. I then had to wait in the large waiting room to 9.35 before I was called in. I didn't even have time to have more than a quick lust after the rather hot receptionist :( or for the coffee to kick in.
Now it is a bit embarrassing when you forget to mention things from your medical history when you are in a Memory Clinic! Nor did the lack of sleep and caffeine help when we went through the first test - you may be familiar with the "remember these three words", a bit of distraction and "repeat those words for me". Fortunately I am ready for the strange looks when I had to relate how I am most allergic to penicillin and plums (one doctor reckoned it was the fungal bloom on the fruit that may be the reason for the second) and the time I was knocked unconscious when my cat hit me with a 20lb iron weightlifting bar. (It was propped up in a corner in my bedroom but she had rubbed her neck on it so it went along the wall to vertical and finally toppled on to my head just as I was waking up).
The Registrar (one down from the Consultant who heads the speciality) took me through the rest of the memory and cognition tests. I got the names of the US President, Prime Minister and Margaret Thatcher right so the coffee had definitely kicked in by the time I had to repeat back an address. Two tasks that got me worried were the timed "words beginning with ..." (had I said that before?) and the names of any animal (can I justify coelacanth? but then fish are animals). One of the tests was to repeat back a series of well known sayings. By that time I was getting on fairly well with her so I did point out that the phrase is not "all that glitters is not gold" even if her check list misquotes it. Apparently I was not the first.
After a bit of physical testing - listening to my chest and testing responses, the Registrar excused herself so she could go over the results with the Consultant. The two came back to give me the news. Rather disappointingly my brain is normal. Apparently the word blindness is common if someone is under stress and they confirmed my suspicion that it was likely I had become focused on the problem so my perception was that it was becoming worse. They were also reassuring that I was right to get checked and they have arranged another appointment for next year just to make sure. Doctors and friend thanked, it was time to head back.
One of the reasons I'd listed the drugs I was on was that I was running out and had recycled the cartons. On the way home I picked up the month's repeat prescription I'd ordered on Thursday - I leave a couple of working days so the doctor can authorize it and transmit it to the pharmacy. It's a long standing arrangement so they know me by name. As sometimes happens, they had not quite worked through a backlog so waiting a couple of minutes while they filled and checked it was not unexpected. For one drug they only had 50mg tablets rather than 100mg so they gave me twice the number of 50s after making sure it was OK. What was unexpected was when one asked to have a word with me in their little consultation area they have for privacy. Mode which had gone from hypochondria to calm now goes to paranoia. Thankfully, all he wanted to know is if I have any adverse effects from one of the drugs and to let me know I can drop in if I want my blood pressure checked. NHS pharmacists get a bonus if they offer this service rather than having people going to their doctors. As it happens, the doctor's surgery has a pod in the waiting room so you can take your own in privacy so I have that covered. Pharmacists are also currently pushing flu jabs but again I get mine from my doctor and remembered to book it today for next week so they do not have to send their reminder.
Now there is a serious purpose behind this, hopefully, mildly entertaining yarn. It helps draw out some of the ups and downs of a "single payer" system and hopefully dispel some of the myths.
First the downsides. There is evidence of some of the problems within the current service. The duplicate pages among other things point to staff being pressed to complete work and not always being able to check it. Some of the processes were not adequately explained because of the standard documentation and it was obvious some things had not been fully thought through from the "customer's" perspective. Nowhere for example was it made clear that the ECG and CT scan had a common location. The fairly small cafe was located next to the maternity unit and the children's center. Maybe good for fathers waiting but it was clearly doubling as the staff canteen - lunch was being prepared in the kitchen. That might be an indication that the catering department has issues. My wait at the pharmacy was due to the electronic prescription having glitches, I gather there were some problems with it transferring the information from the doctors' to them. (This could have been overcome by the pharmacist very easily by getting telephone authorization as they have my prescriptions on their records). Them giving me the 2x50mg rather than 1 x 100mg tablets was the result of a shortage of the larger. Shortages can occur but are usually down to the manufacturers and I think similar things have happened to patients in the USA - or they find twice the number of half strength tablets cost less than the right number of full strength ones.
Perhaps most significant was that the timings of yesterday's tests were not my personal choice. Waiting three months from initial talk to my GP to the clinic appointment would not have occurred if I had had the cash or private insurance nor would I have chosen to kick off at 8.45 a.m. - in the UK timing flexibility is one selling point for insurers. On the other hand, this was certainly not an urgent consultation. Certainly if those bumps were suspected to be cancer, I would have been seen very much more quickly. Currently in England there are targets of a maximum two months between an urgent GP referral and start of treatment. (Note: NHS England is separate and can have separate arrangements from those in the other countries in the UK)
The big upside of course is my total out of pocket expenses for all of this - £1 for the small cup of coffee (I am of an age at which I also get free public transport). At reception all I did was to show the appointment letters - no demand to see an insurance card or for credit card details. At none of the three locations was I waiting for more than 5 minutes. Indeed when I visit my GP it is rare to go more than 10 minutes past the time.
Also, it is very easy for me to get an appointment quickly if I am not concerned which of the several doctors in the practice I see. The first day available for bookings on the phone app is Thursday and I can currently choose one of 10 slots between the five doctors working that day. It also shows the two minutes booked today for the flu jab. If I am suddenly sick, I can sit and wait for the end of the booked appointments and will be see, eventually. If more urgent, I can call the out-of-hours service who will either arrange for a booking at the surgery if not urgent, arrange a home visit that day or call an ambulance. Otherwise, there are walk-in centers including for minor injuries (the hospital I was at has one next to its main "A&E" or emergency room). My doctor's surgery is well managed - witness the use of IT for several functions. They even have a patient log-in system so you can confirm you are attending your appointment to leave the receptionists to fill other office duties. I freely admit that others in other areas may well not have as good a service but this is a comparatively very poor working class area with a lot of social housing and the consequent medical challenges that has for the doctors. Based on my experience, some of the stories about waiting weeks are nonsenses. Certainly if urgent treatment is needed, people can access it.
I can have asthma-like allergic reactions to the perfume in some commercial cleaning products so get the annual flu shot free before I am 65. In fact my GPs gets a bonus if they reach a target proportion of vulnerable patients. I also had help with dieting (lost 20%+ of my initial body mass) and they can even "prescribe" exercise classes. The drugs I get include two for blood pressure and a statin, on the basis that the combination will better prevent or delay a stroke or coronary event that would be more costly for the NHS. Here perhaps is the big difference between the US and UK systems. One promotes health on the basis of cost savings, the other insures in case of sickness.
Looking back what is also remarkable is the professional and understanding way in which I was treated both locally and in the hospital. At no point was I made to feel I was wasting their time. In so many words I was told it was "better to be safe than sorry". Checking out minor symptoms in case they become serious problems is part of prevention and saves the NHS money in the long run. Something that insurance companies do not do on the basis that their insuree could be with another company or on Medicare by then.
One thing that strikes me is whether I would have taken any action if I had a co-pay for the initial consultation with my GP. As it was (and despite the impression I might give), I was nervous about what she might say was wrong and for me it was important to get the "all clear". I had already made some arrangements to stop doing some voluntary work if there were and (silly as it may sound) had put off getting a cat from the local rescue center. In terms of my mental health it is a bonus. Despite the cold and the box of paper handkerchiefs I have got through, I feel much better than I did last week. Britain has a lot to thank David Lloyd George and William Beveridge for and I'll be raising a small glass to them.