I love the NHS, sprawling behemoth of bureaucracy that it is.

[tahariel]

Sure, it would be nice if Mr Bates didn't turn up to his clinic two hours late and make all his patients wait. But he's just one asshole consultant. Most of us work damn hard, and for relatively small pay (it starts off good but doesn't go up much) to make other people's lives better.

I love my job. I really, really love my job. I love helping people and telling people their kids are fine and not to worry. I love working with patients even when there's nothing I can do for them, even though I have to tell them that, because people still sent them to me to see if we could help them - not cutting them out of the system, not ignoring them because they're 'too disabled'. I work with five-month-olds and five-year-olds and fifty-year-olds and eighty-five-year-olds. I work with glaucoma and squints and amblyopia and cataracts, and idiots and wonderful people and people who don't speak English well enough to tell the difference between 'keep patching' and 'stop patching'.

I get into work first thing in the morning and I don't leave until we've seen everybody and all the paperwork is done and we're ready for everyone else to come in the next morning and start all over again. I work my ass off when we're running late - and it's never our fault, it's always because a patient was late or we've been asked to see an extra person because they really need our help - and I sit around waiting for patients who never bother turning up for their appointments.

And even with all of this - I want always to be doing more for people, to be using best practice, to argue for better facilities and tests and to run more clinics and help people more. And you know what? I can do that, if I work hard enough for it. Because that's what the NHS is. We do it out of love, and anybody who wants to slag us off can go pay for their own healthcare somewhere where the doctors give them extra appointments and extra drugs that they don't need because they get paid more that way, and ask for their insurance details before they'll set a broken leg or take five seconds to check their kid for a squint.

Comments

[frodo-esque.livejournal.com]

Excellent!

As someone who is pro-Obama's new health plan, I stand and applaud this post. =) I hope those who oppose read this.

[tuppenneyrice.livejournal.com]

Hurrah for the NHS! I'm following the whole American healthcare debate and it's cheering to read someone who thinks that a system based on need not income is a good idea too. Particularly on a day when one of our own MEPs basically just called the NHS a waste of space.

Glad to hear the job's going well too (you met me at Sarah's thing in London)!

[tahariel.livejournal.com]

I majorly object to being told that essentially my vocation, and my job, is evil and/or useless. Gee whiz, really makes me want to help this guy when he comes begging to us for medical care.

[elmathelas.livejournal.com]

Hi there. I saw your post on the wrisomifu community and I was intrigued by your mention of a hospital placement last year. Are you an optometrist?

I appreciate this post, and I recognize a lot of your sentiments as my own. I'm an NP working in the US in a family practice clinic and I refer people to optometry all the time. I know enough to know that the training I had in eyes is not enough to really help them in some cases.

I do sometimes have to ask people what their insurance is, but only to figure out what I can do for them without the stress of payment driving them deeper into illness from stress alone. I wish I didn't have to spend even 1 second of my day doing that, and there are times when I spend whole minutes per patient dealing with that, which adds up.

There are other times when patients ask me, how dare my insurance not pay for XYZ drug? And I tell them, look, there's a cheaper option that may work, doesn't it make sense to try that first? But in the US people have heard "don't let the insurance company tell your doctor what to do" so many times that common sense just goes out the window, and they think that autonomy means that I should prescribe whatever is advertised on the television any given morning. (Oh yes, we have drug advertisements on the television.)

There's this perception that in non-socialized medical systems providers get paid more for prescribing more drugs, and I don't, and I don't know of any model where the provider does get paid more for that. I do get paid more for seeing more patients, but that's more of an incentive (set up voluntarily by my employer) for me to say sure, stick one more in at the end of the day, squeeze one more in at lunch, more than me telling them to come back unnecessarily so I can get paid a tiny bit more on top of my salary. When I tell people they must follow up it's because I truly need to see if the intervention we decided on is working or not. It's not fair to a patient for me to start them on lifestyle changes or a drug or a treatment regimen and then not see them for a year, but even if I let everyone follow up in a year I'd still see plenty of people. Diabetic patients have every 3 month follow ups and sometimes I get accused of trying to milk their insurance for more visits, but really, there are much better outcomes if there is q3month follow up and I have a responsibility to make sure that their tests are done, they're up to date on their drugs or insulin, they have enough testing strips, they saw their eye doctor, and check their feet, etc.

So. anyway. I'm working in a capitalist system, but overtreating to get more money out of the patient or the insurance company isn't part of my practice, or the practice of any of my colleagues, though I haven't done an exhaustive study to see how prevalent it is overall. Over-testing to cover my ass so I'm not sued might unconsciously be part of my life, I'll admit, but I try very hard not to do that either.

Unless they come in with "omg the swine flu I'm sure of it" and I stay late to see them and I go in and there is NO WAY they have influenza. I'll admit I swab them spuriously for flu just to be able to say that I did it. And who knows. some day they just might.

Writing every day after I've spent 10 or so hours delving deep into the physical and mental woes of 20 to 25 individuals isn't always the easiest thing-- hence wrisomifu.

[tahariel.livejournal.com]

Hi there, always happy to talk to new people :)

I'm actually an orthoptist - you may know, but most people don't know what that is, so don't worry if you don't. It's a related field, anyway, so close, but no cigar :)

I think we probably has as skewed a perspective on American healthcare as Americans seem to do of ours - certainly I've read papers where it's been pretty obvious that practicing in the way suggested would involve a million more appointments, and the paper has been written by an American author, which is where I was coming from. But I fully confess to having no personal experience of the system, so am very happy to be wrong.

I knew about the TV adverts - and I find them really weird. Is the patient really expecting to know better than their doctor what they should be taking just from watching a two minute ad on the tv?

I'm actually at work at the moment, so I'll cut my reply short and just say, hope to see you soon at wrisomifu :)

[elmathelas.livejournal.com]

I had to look it up, I was only familiar with optometry and opthamology. (I used to be an optometric assistant). In the US an opthamologist or would deal with disorders of the eye muscles, like amblyopia and the like. Prism exercises are often prescribed by opthamologists and more rarely by optometrists.

Did you ever see the Peanuts cartoon where Sally has amblyopia and she has to wear a pirate patch (since it was pre-adhesive times)? I looked and looked for the book that had the cartoon in it when I worked in an optometrist's office, to make a booklet or something for our young patients who were patched, but I could never find it.

[tahariel.livejournal.com]

I've been told that there are orthoptists in the US, but that there are very few, and that they're treated more like technicians than as separate professionals. In Canada it's more like it is over here, apparently.

I've never seen that cartoon - will have to look it up!

[elmathelas.livejournal.com]

OMG, here it is:

Sally has an eye patch. (http://www.tompreuss.com/2009/04/27/amblyopia/)

There were at least 3 strips about this, and perhaps some others where she just appears with the patch as part of her usual getup, but I think maybe this is the only one that has been re-run in a while.

[tahariel.livejournal.com]

That's awesome! I'll have to show it to my boss!