AIBU to not understand the english attitude towards the NHS?

[EggplantsForever]

Every time someone criticises the NHS, every time someone asks for better health service, or to have some not absolutely vital procedure (like IVF) covered, or to be referred to a specialist there is a barrage of voices here calling them "ungrateful", proclaiming that "the NHS is on it's knees", etc.

I just find it so peculiarly English and I have very hard time understanding it! Perhaps you can explain?

I mean, it is almost as if people feel that someone very nice and kind has given the English people the free health service, and they should be eternally grateful and not mention its shortcomings or it will be taken away. But the NHS is in fact paid by your own taxes! It belongs to you. And you have full right to criticise it and expect it to work just as well as other free healthcare systems in the world. Which it doesn't. It actually compares pretty badly even to the countries that spend less money per capita on health. I have a feeling it is actually badly mismanaged.

For example, look at this table en.wikipedia.org/wiki/List_of_countries_by_quality_of_healthcare
UK is at the bottom at most of them, below Portugal/Spain, Israel, and Slovenia who spend significantly less money on healthcare.

From my personal experience, having lived in a country with free healthcare, you could go to a gynaecologist without referral (and women were advised to see one for a yearly check up). Skin specialist did not require referral either. Referral to any other specialist took me on average two weeks. IVF was available to everyone for free. The list of cancer drugs included drugs that are not funded in the UK. etc And people still routinely complained about their healthcare. Which they had full right to do, because it was funded by their own taxes.

So I am just not sure why is everyone so afraid to criticise the NHS? It is actually one of UK's biggest problems. And why does everyone eternally fear that it will be "taken away"?

There are definitely ways to improve the NHS; I think that citing a limited budget is a cop out that allows them to avoid meaningful analysis and change to take place.

Exactly - blaming a perceived limited budget is the lazy excuse. A lot of it's problems are absolutely nothing to do with money, such as the patronising "know it all" attitude of far too many healthcare professionals whose default position is that the person in front of them is a thick idiot who doesn't deserve their time and should be grateful for whatever poor service they "enjoy" because it's free.

The limited budget excuse really is preventing any meaningful exploration of all the other problems.

In India people who have heart attacks that could have been treated in the UK, die because hospitals need to take and clear payment prior to even an emergency case.

In the US people still have to make choices such as college for daughter or hospital treatment for mum.

The NHS is unique and amazing and we absolutely should be both proud and grateful for it.

The NHS is unique and amazing and we absolutely should be both proud and grateful for it.

But India and US are only 2 alternatives. There are plenty of other countries using alternative healthcare models that people are happy with.

The GP referral system here is just such a waste of time and money. In Dubai (arguably using insurance) if I needed a gynocologist I booked to see one or if I needed a dermatologist I booked one which just seemed so efficient compared to here.

I don't know why it's assumed here that people are too stupid to know what service they need, followed by a lengthy wait of several months. And then you need to take two days off work for what should be a quick appointment.

In the US people still have to make choices such as college for daughter or hospital treatment for mum.

You don't think they have to make those choices here, in the case of chronic conditions? People could have treatment more quickly privately in some cases, than on the NHS - such as hip replacements, having both cataracts done quickly rather than being rationed to one, MRI scans, the latest cancer treatments....Question is can they afford it, and still be able to eat, heat their house, etc?

The hidden price for NHS rationing (and gatekeeping by GPs) is patients' suffering; its just there is no monetary value for it in the decision making, even though the economic costs are still there for the families!

@hellomumsne.. I am a gp, and very experienced at that. How insulting that you think that you and the public know better than.
I saw at least five patients on Saturday morning who thought they needed a specialist, but in fact had conditions I was well qualified and able to manage perfectly well in primary care.
If the public could merrily just book to see a specialist on the NHS can you imagine what the waiting times would be? Goodness only knows.. Clinics would be full of people who had self diagnosed via Google and people who genuinely need a specialist would be pushed further back.
Not to mention the harm this would do to the people who suffer from real health phobias.. They would literally be at an appointment every day.

@theredjellybean don’t mention your a Gp on here you will be a) lynched and b) told you know nothing!

In the US people still have to make choices such as college for daughter or hospital treatment for mum.

You have to make choices in the UK under the NHS too. My OH recently had to make a very difficult decision, i.e. whether to undergo a serious medical procedure or not. The information/advice given by the NHS "professionals" was absolutely shocking - different people telling us different things, "professionals" willfully with-holding highly relevant information, very "glib" comments from specialists. Quite simply, we couldn't get any reliable information and really had to press them time and time again as to pros & cons, risks, opportunity to delay, etc etc. As it turned out, had we just gone with the flow and let them do what they wanted in the first place, it would have been the wrong decision. All the way through, they had an arrogant attitude that they knew best which actually turned out to be wrong.

How insulting that you think that you and the public know better than.

Sometimes, even members of the great unwashed who you seem to despise know what they are suffering and what services they need.

My son had an ingrown toe nail - it needed removing. I knew that because I'd suffered one as a child. It took several appointments over some months, with GPs and nurses telling us different things, each time I asked about it being removed, before we finally insisted on a podiatry referral, and it was then removed within 2 weeks and the matter cured.

I suffered worsening hearing and needed a hearing aid. Took 3 GP appointments before I got a referral to the audiology dept.

My OH had a very painful leg/back for a few months. Over that time, several GP appointments, again, each time asking for a physio referral, but GP kept saying just wait and see and offering painkillers. Finally, again, had to insist on a referral.

Lots of the general public are quite capable of knowing what services they need and making direct contact. All the "gatekeeping" role is achieving is wasting multiple GP appointments and making GPs think they're important.

And so it continues

The Michael Moore documentary Sicko always sticks with me when people slate the NHS. There’s a man on that who literally saws his own leg off because he can’t afford healthcare, this was in the USA about 15 years ago.

I, like many others, owe my life to the NHS. It isn’t perfect of course but it’s invaluable to so many people across the UK.

@hellomumsne.. I am a gp, and very experienced at that. How insulting that you think that you and the public know better than

And that is the kind of arrogance that we are trying to stamp out in the NHS...

Maybe everyone should be issued with a surgical kit and an assortment of medication - we could all sort ourselves out if we don’t need gps!!

How dare a GP who has gone through many years of medical school and practicing medicine tell someone who hasn't they they know better.

It would be like me arguing with someone with a PhD in quantum physics that I understand better the law of subpar tickles than them! Honestly some people really think way too high of themselves just because they have become Internet warriors!

You are assuming that I am not medically qualified?

I have a pain in my side, I’m gonna tell the gp I need a chest X-ray, Sod everyone else I want one

Too many exclamation marks and cliches being bandied around, it will be accusing people of being keyboard warriors.

The most dangerous type of medic is one who is arrogant and thinks they know it all. No one knows it all and sometimes it is good to listen to patients and not treat them as complete idiots.

I’m off, boring now - too much winging on here. I’m glad I’m not a gp and have to put up with all this “i want I want and I want it now”

I never said I know it all, but if my years of studying and years of experience count for nothing because the patient must always get exactly what they believe they need, then yes stamp out GPS.. You clearly don't need them.
Clearly if my patient believes they need to see a specialist then it is arrogant of me to take the time to take the history, exam them, discuss what I think is going on, discuss and explain the treatment or investigation plan and then organise that for them, it's arrogant of me to presume that I might know how to do my job... I mean I could just knock off a two line line letter to the referral centre saying 'please see Mrs blogs, I don't know what is wrong, I haven't bothered to try to find out cus she thinks she needs a specialist'.

Read back how you talk about your patients, you sound very disdainful of them.
Arrogance has been repeated throughout this thread as a problem, that seems to have been twisted round by some to patients thinking they know more than medics.

Sadly it is because of that attitude that is leading to GPs not having the energy to try to gain the trust of their patients in 10 minutes or more like having to justify themselves for not referring to just indeed just draft that letter even though they know the specialist won't be able to help.

The same patients who of course than moan that the waits are too long and then the consultant is incompetent too. Yes, like in any field, there will be error made, so patients trying to educate themselves is always a good thing, but it should drive dis ussion, not telling the GP what they should do and that they know better than them.

I have not been disdainful of my patients.
I am pointing out why a system by which non qualified individuals could choose to book a specialist appointment at their own discretion is firstly an idea that would cripple the NHS completely and secondly I have pointed out that posters stating that they know they need xyz... And a gp would not know differently is rather arrogant.
Do you believe that my training and years of experience count for nothing?
What you are all describing is a wants led service not a needs led service.
Sometimes not giving the patient what they want is the right thing for their health.
That's not arrogance, that's doing my job.

Lots of the general public are quite capable of knowing what services they need and making direct contact. All the "gatekeeping" role is achieving is wasting multiple GP appointments and making GPs think they're important.

^This! Why do people think the equivalent of not having referrals is people running off to get an MRI when they feel like it? That's silly. Of course you would still need to see a professional in the relevant field who would assess what course of treatment/checks/scans you need and prescribe them accordingly. Nobody is talking about walking in and demanding a chest X-ray - merely having the option to go directly to a specialist who has better knowledge of the area that is problematic. Hats off to GPs - they are smart and brilliant people - but they won't know and diagnose things that a specialist, who has undergone years of specialised training, does.

theredjellybean - but isn't the whole point of a general practicioner that you see before a specialist that the GP can look at your health as a whole and then see what specialist you need? I've heard of so many GPs who refuse to do this and will only tackle one symptom at a time. If it's one symptom at a time, why not just go straight to the specialist, from the patient's point of view? It works in other countries. (not talking about the financial side of it)

In many ways yes but there seems to be this belief that GPS are not capable of dealing with many problems and people need to see specialists.
In my experience I am seeing increasing numbers of patients who don't have any faith or respect for my experience or knowledge and want to go straight to a specialist because they believe they know that is what there health condition needs.
Many many things are managed in primary care, and while some patients might know they are going to need a specialist most don't have that level of expertise.
I routinely get told by patients that they are "just here to get a referral" before I have even asked them what is wrong... 9 times out of 10 they don't need it.
Now if those people had direct accces that's a lot of unnecessary appointments with specialists... And what will wait times be like then? And what happens to the people who genuinely need specialist help?
There is a huge problem in this country with increasing numbers of people who suffer from health anxiety. I see at least 2-3 a week, they would be booking appointments constantly. As it is they can be managed in primary care.