Further Confessions of a GP

One of my young Polish patients asked me why doctors in the NHS only prescribe paracetamol. The answer is, of course, that we don’t. I prescribed him paracetamol for his slightly sore knee and explained that it would get better on its own. He told me that in Poland he would have got an X-ray and seen an orthopaedic surgeon. I also prescribed him paracetamol for his viral sore throat. In Poland his doctor would have apparently performed a chest X-ray and given antibiotics. I have prescribed him only simple painkillers for his ailments because they are benign and due to the amazing self-healing power of the human body they will get better all on their own. He is a fit 28-year-old who doesn’t need extensive medical investigations for his minor health complaints, but were a privately run health clinic to be set up in our local town, I suspect he would happily part with £70 to see a non-NHS GP. I’ve not seen many private doctors prescribe a cheap drug like paracetamol when they can prescribe numerous more expensive ones. It would also be lucrative for a private practitioner to order as many expensive investigations as possible. These should be done quickly, as once the patient gets better, he may not be quite so willing to part with his credit card details.

Going against the grain, I do have one Polish patient who isn’t quite so critical of the NHS. She is only 23 years old and has been working here as a waitress. She came to see me one afternoon with a lump on her arm. It was hard and craggy and felt like it was attached to the bone. I placed her urgently on the cancer referral pathway and within 10 days she had seen a specialist, who unfortunately agreed with my diagnosis. She had a rare aggressive bone cancer called an osteosarcoma and it needed urgent treatment. She was sent to the Royal National Orthopaedic Hospital in London where she received top-notch cancer treatment and the sort of specialist surgery that only a few places in the world can offer. She is now back at work with only a small scar on her forearm to remind her of her recent brush with death. She went back home to Warsaw last month to take her notes and scans to a Polish doctor for his opinion. He told her that the management for her condition in Poland would have been to amputate her arm above the elbow.

Those most ill tend not to be the ones who complain loudly about the NHS. A person who has been hit by a bus or is being treated for cancer tends to sing praises for the treatment they receive. The private clinics steer well clear of those who are seriously unwell as there is no money to be made from them. I can’t imagine a team of private doctors offering to set up an independent A&E department. The private sector prefer to cherry pick the fortunate majority, who are basically fairly well but are often disgruntled with the NHS. The private health-care system in the USA is extremely lucrative for the same reason. They also make their huge profits by targeting their services to well people. For example, they have scared the population into believing that they all need yearly colonoscopies to screen for bowel cancer. Each colonoscopy test costs on average $1,185, while here in the UK we test poo for signs of bowel cancer instead which costs around £10. Studies suggest that both techniques have similar levels of effectiveness as a screening tool, but the American insurance companies can’t make any money out of a £10 poo test. Of course, the real crime in the USA is that people with bowel cancer but no health insurance die, unable to afford a colonoscopy or the potentially life-saving treatment they need. Thank goodness for the NHS.

Much as I love the principles of the NHS, I don’t live in a bubble and I would be the first to admit that it can be a bit rubbish sometimes, as can some of the people who work within it. We need to constantly root out our failings and strive to improve it from within. Sometimes this feels like an impossible task and when the NHS is on the receiving end of a constant barrage of abuse from the media, it can be tempting to look to the private sector as a way out. A private health clinic recently asked me if I’d consider leaving the NHS to become a private GP. I said no, and for two reasons. The first was that if patients are really sick, there is nothing better than our local NHS services. Secondly, I became a doctor to provide sick people with what they need, rather than offer well people what they want.

Don’t look down

‘Don’t look down, Ben,’ I was saying to myself over and over in my head. My throat was tightening and beads of sweat were forming on my forehead. No, I wasn’t walking a tightrope across the Grand Canyon – it was much harder than that. I was trying to maintain eye contact with a patient and avoid looking down at her ridiculously enormous breasts.