Survival of the Richest

Yesterday I started my first full week of recovery from my bilateral knee meniscus repair arhroscopy. That’s corrupted medigeekspeak for “my knees were busted, they knocked me out, stuck some instruments into my joints through a couple of small holes, cut some bits out and fixed it all up again”. I had time to sift through and review the half dozen or so letters sent by my GP. Every time a consultant wrote to her, it jogged her into writing to me. I thought GPs were beyond Pavlov, but what do I know?
I had this knee procedure privately. (Didn’t think the NHS would take care of something so trivial as my ability to get my health back into shape!) In a separate post, I will compare this experience with my recent stay at St. Mary’s. I can assure you that the NHS comes out very badly in this comparison. Of course, we must bear in mind that we are comparing apples to oranges, but that shouldn’t detract from the fact that we’re still operating entirely within the domain of fruit and that it is sometimes very pertinent to compare different fruits.

Back to my GP. I called the surgery today. I don’t like GPs. Nothing personal. It’s just that for the last decade or so, they have been utterly rubbish. Is it their fault? Probably not. Like I say, I don’t know why the NHS is shit. I just know that it is shit. I very briefly gave the receptionist a precis of the situation. She was, as always, utterly disinterested in the human aspect of my call, or the embarrassment of her boss, the doctor.

My line was “My GP is desperate to see me, because while she has been messing up my prescriptions, consultants paid by my insurers have investigated, diagnosed and treated me for two Transient Ischaemic Attacks and fixed my knees – and told her about it half a dozen times”. The subtext? “The NHS has been made to look bad because it is slow, disorganised and careless. Meanwhile, the private sector has been totally ‘customer-focussed’ without trying, which I thought was the point of the NHS reforms…maybe I was really naive!”. The receptionists interpretation? “You want an appointment?”

So, I went to the back of the queue and learned that the earliest slot they had for a diabetic getting butt-fucked by his disease was Thursday afternoon. Not good enough of course, because apparently, my GP wants me for a “double-slot”. Great. A double-slot. That means instead of the usual ten minutes (after having waited 60) i get 20. For what though? What will my GP do that my diabetic consultant at St. Mary’s doesn’t do already? I was told to call back at 6p.m. for a cancellation. I forgot. Or maybe I just didn’t give a shit, because the next available appointment wasn’t until December 27th. That’s right. A 10 day wait to see a GP who has written to me half a dozen times in knee-jerk response to private consultation prods.

I know they’re busy. Don’t they plan though? By chance, my wife had an appointment today with the same GP. It took my Groundhog Day GP the whole of the appointment to figure out that we were related. Groundhog Day? Yeah. She’s made this connection twice before. She boasted to my wife that she was in charge of Diabetes at the surgery and should be seeing me four times a year. Well if that’s the case, why is she chasing me only after the private sector saved my life? Because if I was still getting NHS care, well, let’s just say that they’d be trying to rehab a post-stroke-vegetable right now, and not a meniscus-repair patient.

Increasingly, I don’t see how a GP is of any help to me. Of course, that is a very narrow view, but that is what this blog is for, to serve my narrow view. If you want a broader view, do what I do, read other blogs too and make your own mind up. A GP is a flood barrier. You make an appointment. If it’s anything like my old GP, you have to wait anywhere from a week to three weeks. Yes, I have had to wait for three weeks on several occasions to see a GP. By the time the appointment has come up, the problem still exists, but you no longer care. You’re not going to die, so you didn’t go to A&E.

I have been a little hard on the surgery. They are not bad. My last surgery was hi-tech, clean, wealthy and shit. I once complained to a doctor there, who behaved in a loathsome manner. She insisted that I leave the surgery and call her from outside if I wanted to talk to her. I said “You are standing in front of me, can’t I just quickly ask you a question now?” She insisted I leave. I told her my diabetes was in bad shape, that I was homeless, that I had enough money that day for one meal and that if I called her from outside, that money would be gone. I begged her to understand. This woman who had “treated” me for some years responded with the fabled concern of the healing profession. “That’s not my problem”.

I once called this GP and asked if she could come and see me. I didn’t get to speak to her, I got the receptionist passing messages. I explained that I was a type 1 diabetic and that I was getting tachycardia, breathlessness and I felt like I was going to pass out. My resting pulse was 180bpm and I was sweating buckets. I didn’t feel well, but I was not getting chest pain. I was told to come to the surgery. I told them that I didn’t feel well enough to. It was a 25 minute walk. When I arrived at the surgery, I collapsed and was taken to hospital in an ambulance. Condition? Thyrotoxicosis relapse. GP? Utterly fucking pointless. If a GP is not prepared to come out, then the bar is set too high and they are useless.

I have never wasted my GP’s time with mundane conditions. I don’t do mundane. I do hardcore. I wouldn’t have bothered anyone about my mini-strokes had I not been told by my employer to get a full health check. These GPs have the audacity to talk about “shared care”, but the truth is they know fuck all, they do fuck all, they’re crap at diagnosis and they don’t like you wasting their time. If you see them by the way, you are a waste of time. If you are in surgery, you are a waste of time. Shared care my fucking arse. The only people who have helped me manage my diabetes are the staff at St. Mary’s. Big shout by the way to Clare Poulter. She has always been hugely helpful and supportive and is available. When I had my TIAs, she was the first person I tried to contact. She is still the only person in the NHS I have ever been able to reach by email. When I went private, I had my consultant’s mobile phone number and email address. How many GPs give you their business card? It’s off to NHS Direct for you son. They will tell you to take a fucking paracetamol or get your arse down to A&E to fight it out with the drunks and thugs.
Not all GPs are shit. Or rather, they weren’t always that way – and to be fair – my current surgery is way better than the last one.

I had a decent one before the self-righteous male-hater I had at the surgery I was at before… Dr. Williamson – and before him, Dr. Galbraith. Giants of the medical profession, in my book anyway, and I will always have a soft spot for them. The latter missed my thyrotoxicosis though – and the former inspired me to live to 40. He was not patronising. He turned up at my home when I was close to DKA aged 14 and he told me gently the story of another diabetic he knew who died before 40 because he didn’t take care of his diabetes.

I’m 40. I’m still here. And in a few days, I will turn 41 and will have hit a massive milestone. Dr. Galbraith told me in 1980 “I want to see you make it past 40, OK?”

Now why does my GP want to see me? Why has she got two minutes to talk to my wife about how great she is at looking after diabetics? (She explained that she was responsible for getting the average HbA1c down from 11% in her clinic to 8%) Why can’t she pick up the phone and call me? I mean, fuck it, my diabetic consultant calls me when something is wrong – and he works for the NHS!

I want to mention him by the way. This man is so good, has such a wonderful manner, is so assured, so supportive, so pro-active that I credit him with having given me a second life. His name is Dr. Valabhji. I’ll talk about his clinic some other time, but he is so good, that when I was ill recently, having suffered the TIAs, I arranged to see him privately. The NHS wouldn’t let me see him sooner, in fact, they told me that my appointment had been pushed back by a month. As usual, I gave up. It was my employer who reminded me that my health policy allowed me to see potentially the same consultant privately. I saw him the following week.

The machinery swung into action. I was educated and medicated. Privately, things happen very, very quickly. He referred me to a neurologist. I saw him in days. Do you know why that is really important? It’s important because I’m not crapping myself in the time in between about what might be wrong. It means I get closure fast and can begin healing fast. It keeps one positive. It keeps me focussed on getting better, and not on how ill I might be. Getting treated privately meant things moved so fast that I didn’t have time to think about illness.
So you can see why I saw my GP contacting me as the lumbering NHS attempting to close the stable door after my health had bolted. It wasn’t my health that pressured my GP into doing something. It wasn’t me, the customer. It was her pride. It was the private sector that humiliated her into a state of concern, which I now see as utterly pointless.

When I was ill last week, before my NHS experience, my wife called the GP at night. What was the emergency number you think she got? That’s right. NHS Direct. A call-centre where the default responses vary from “take paracetamol” to “get yourself down to A&E”.

“I’ve got a headache”

“Take paracetamol”

“But it’s really bad”

“Take 2 paracetamol”

“But my body is paralysed down the left side and my tongue is numb”

“Get yourself down to A&E”

In the old days, you called a doctor if you didn’t think you were going to die, and an ambulance if you thought you might. Now, A&E is the front-line for everything while GPs are tucked up in bed. So I might be a diabetic having suffered a mini-stroke, smashed my face and head against the sink in the fall and massively dehydrated, but I have to compete in triage with the drunk who cracked his head open after tripping on his own vomit. Or more likely, someone who’s been in a fight.

When we called NHS Direct, I remember asking why GPs didn’t come out anymore. The response was asinine and irrelevant “Because people were abusing the service and calling doctors out to get them paracetamol”.

Right – so I’m telling you, then when I’ve got really ill, my wife is telling you, that I’m vomiting, I’m type I diabetic, I’m coughing up blood and I’ve had two recent TIAs and you’re telling me you might get me confused with someone who wants some paracetamol dropped off?

Who runs this system?

Yes, I am able to get private treatment. Yes I recognise that the NHS has served me well many times. And no, I don’t think the NHS is going to be able to keep me well in the future. I’m glad I can afford private health care. I don’t fancy dying just yet. And I know, with utter conviction, that my health left in the hands of the NHS alone will result in death. And this in spite of the utter brilliance of some astonishing doctors, surgeons and nurses. To those of you like Dr. Valabhji still serving the NHS, I salute and applaud you. To those who have left, I don’t blame you.

And to those who do the NHS a disservice, including lip-service nurses and system-serving doctors – leave – you are not helping sick people. As for the administrators and ministers who have turned hospitals into MRSA breeding labs and resource-stripped skeleton-centres – I hope you get to see what you’ve done, first-hand.