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"?

Here in Germany you self-refer to the gynaecologist for a smear and breast check every 6 months. You go to your first appointment with one when you get your first contraception. I.e. when you are a teenager.

Yes, it might all be a bit too thorough (as Germans are), but it does mean things like endo, PCOS and other problems are picked up rather than ignored until they have done their bit in ruining the lives of their victims.

On another note: I had my first smear in 15 years this year from my gynaecologist here and I can't tell you how comfortable that was (this is not a typo!). When I see the horror stories on here, I genuinely feel this procedure is mismanaged massively in the UK. I had two smears and breast checks from my GP in Belgium which were the most uncomfortable occasion ever. I genuinely believe the man was nervous and f*cked up big time. .

Gynaes have the right training/technique and above all the right equipment (think the dreaded chair with stirrups) to do this as painlessly as possible. Vaginal exams are not painful when your pelvis is tilted the right way and you don't get that on a straight couch (as I know all too well from my midwife's practice).

There is stuff here you have to be referred for or you have to pay for it, but it never takes long. In fact they rather refer one time too many than not. The only reason why it takes long in the UK IMO is that there are not enough specialists because money is being squandered and doctors cannot establish a practice when and where they want.

Pretty sure I saw statistics saying 60% of cancers weren't caused by lifestyle choices!!

You did. In the US it's 58%.

Cancer deaths linked to modifiable risk factors

There's also no reason to think that modifiable risk factors like obesity or lack of exercise are substantially worse in the UK than elsewhere in the developed world.

And it's really not on to blame the patient. Are you going to refuse to treat someone's colorectal cancer if they ate meat?

If you want to reduce cancer death rates it's pretty simple. You test more aggressively to catch cancers early when they're more easily treated. I have a risk factor for colon cancer so I get an annual colonoscopy. That simple practice has a very good chance of saving my life.

Not to mention that these risk factors do not necessarily lead to cancer. Who's to say your cancer is not just genetic?

I remember not so long ago smoking was seen as the leading cause of throat cancer. As the younger generation smoked less, but got more throat cancers, it was obvious there must be another cause: oral sex. Yet all these smokers could have been demonised for 'bringing it onto themselves ' (it's the same with oral sex really, but that definitely gets a better press).

Most cancers are still a mystery as to why they occur, and yes, there are risk factors, but they are not causal so you can't blame the patient for them other than their genes.

What's rational about it taking almost a DECADE to get an endo dx? And that's an improvement!

Rational arguments I'm more than happy to consider - I've yet to see one!

And frankly I think myself and others who've suffered as a direct result of these attitudes and incompetent behaviour have a right to be angry!

"Because in so doing all the neurotics and health anxious..." Are you an hcp? Because this seems to be hcps defence to why many patients aren't getting the dx and treatments they need. There are numerous examples online, far from just on mn but tons on here too of patients ESPECIALLY women being dismissed as "neurotic" or "anxious" when actually they DID have something wrong - up to and including conditions that proved fatal when they needn't have. This attitude is quite literally resulting in deaths!

"I had referral and hysteroscopy from a phone call with my (fantastic) GP within a day" your GP is indeed fantastic - ime and from reading here and elsewhere that of many others - that is incredibly rare. Even when the patient is presenting with symptoms that are seriously impacting their life.

"There aren’t enough gynaecologist post funded or doctors trained to see everyone with occasional spotting." Wow! Do you REALLY think myself and others proposing this are doing so due to "occasional spotting"?! Try extreme blood loss, anaemia, pain bad enough to cause fainting and vomiting & even serious anaemia that when others witness it consider it an emergency situation yet we're having it every month, severe back and leg pain to the point it's difficult to walk, agonising migraines, diarrhoea so bad your lucky if you make it to loo on time... Yea we really should just put up eh?!

As for the "there aren't enough Drs" that's hardly the patients fault, nor is it a good enough reason for lack of referral/treatment.

"It’s sad you’ve had endometriosis." Yes it's sad having endo - but it's fucking tragic losing babies or being left infertile as a result of Dx being unnecessarily delayed! It's tragic that patients are being left suffering for DECADES because they're being prevented from accessing correct treatment.

"Nobody surely suggests hysterectomy should be done lightly in such a young woman without trying all other options first - and that takes some time." I wouldn't be so sure about that - there's several mners have been "offered" hysterectomies or even have had them, only to learn later that there were many treatments for their gynae condition that are supposed to be tried certainly offered that they weren't even informed about! It should absolutely be a last resort especially in young, childless women.

As for smears, I'd be more than happy if it were even a gynaecology nurse doing rather than a practice nurse. Your experience may be that practice nurses have been fine doing it - many women haven't found that to be the case. Many women find them rushed, uncomfortable and if you DARE say so you're treated like you have a nerve for complaining!

"If they’re such a problem, get a prescription to take beforehand to make it easier or determine your degree of risk in consultation with your gynaecologist/GP and make a decision not to have them (certainly not advocating for everyone but we overscreen and some women have a very low risk)." Medicating patients unnecessarily, as a way of making patients able to deal with clumsy inconsiderate hcps, or leaving them cut off from an important diagnostic procedure is a completely unacceptable suggestion.

Btw my aunt that had cervical cancer? Had been going regularly for her smear tests - turns out the practice nurse concerned had been doing the procedure wrong in some way resulting in false "clear" results. Huge scandal at the time, 100,000's of women affected including too many who died as a result.

"People need to start taking responsibility for their own cancer prevention and not simply expecting the NHS to cure them." People do, but even where they don't completely they're human. Almost all conditions could be argued to be "patients fault" I'm fairly certain you're not perfect in this regard, few people are. That doesn't mean it's acceptable to not dx and treat. Plus - these factors merely increase the risk, they are rarely direct cause if they were EVERYONE who smoked would get cancer, EVERYONE who'd been exposed to hpv by unprotected sex would, EVERYONE who drinks too much alcohol or eats too much would. It's not as simple as that. There are genetic and environmental factors too.

"They get a proper discussion about the right contraception for them" yes - without the mirena hard sell too!

And sometimes people have more complex issues. I had to go to my GP for about a year until she admitted she didn't know what was wrong and sent me to a specialist. Turned out it was the wrong specialist, but it was only the gynae who figured out what it was.

It really shouldn't take this long for a dr to admit they're stumped and call in extra help.

Swingofthings - 6 weeks wouldn't be too bad - BUT how long have those patients been seeing their gps for that issue BEFORE getting to see a specialist? That could well explain why, especially if they're in pain, they just want it FIXED! Plus people have lives to lead! Orthopaedic issues usually involve significant pain levels, people perfectly reasonably want to be able to get back to living their lives, including working ASAP rather than have ANOTHER 6 weeks of trying something that may well not work.

I find it very interesting that despite trying several different search terms I cannot find official stats on how long it takes from a patients first appointment with a GP to being referred to a specialist, even when I look at specific conditions. However plenty of personal stories on sites relating to specific conditions where patients are telling of many years of going to gp and basically getting nowhere, eventually getting the referral and then specialist quickly Dx the issue and treatment out in place. Often the specialists are frustrated patients aren't being referred earlier.

"Gynaes have the right training/technique and above all the right equipment (think the dreaded chair with stirrups) to do this as painlessly as possible. Vaginal exams are not painful when your pelvis is tilted the right way and you don't get that on a straight couch (as I know all too well from my midwife's practice)." Completely agree. The crappy narrow, flat "beds" we use here definitely make matters worse. Whenever I have one the fact that when you get into the prescribed position means I feel like I could fall off any minute makes me tense up! Not to mention the fact that I've had too many times the experience of being in that very vulnerable position (physically and emotionally) and other staff members of the practice have "popped in" to the practice nurses office mid smear! I don't care if there's a curtain BARELY providing an illusion of privacy, that's a time when it should be absolutely unacceptable for people to "pop in"

Staff popping in mid smear
????? With only a curtain for privacy???

Seriously? And no-one finds this unacceptable enough to complain very loudly?

The practice assistants at my gynae wouldn't dream of popping in, and he's got a room for talking and one for examining.

Incidentally, the neurotics and mitochondriacs don't seem to be such a problem for the systems abroad. So why should they be for the NHS?
There is gatekeeping here as well, but it doesn't seem to affect referrals.

A short while ago my husband had shingles on his face and around his ear. He got referred to ENT within a few days as well as ophthalmologist. Then he got paralysis in his face so was referred to hospital within the day. The only slight hick-up in that procedure was A&E not wanting to formally admit him without paper referral from his GP who was phoned at lunch time personally, who contacted his assistant who faxed through said referral all within the space of 15 minutes. He got examined for anything and everything apart from shingles too. After discharge, he had to go back to GP who referred him for physio (which wasn't needed in the end) and to the neurologist to follow up on the facial paralysis. He's probably going to be discharged from there too, I guess.

If people aren't helped properly, they start being anxious though. So the longer the GP hesitates (whether that's because they'd be told off for referring too much or not), the more a patient thinks their condition must be too complex and therefore too serious to deal with.

"There's also no reason to think that modifiable risk factors like obesity or lack of exercise are substantially worse in the UK than elsewhere in the developed world."

Well we know that obesity is worse in the UK than in most of Europe. Of course there are some countries in the world where it's even worse.

"No, you’re not about to get a consultant gynaecologist do your smear. "

I had a consultant gynaecologist do my first smear and she was much better than the practice nurse I had afterwards.

TRIGGER WARNING

"Staff popping in mid smear
????? With only a curtain for privacy???" Yep, very common I've had this happen at almost every practice I've been with. I hate it! I'm a survivor of csa so male members of staff doing this really distresses me but once it's done it's too late really. I've had half hearted apologies but no more.

Numerous threads on mn and elsewhere, where women report painful, embarrassing experiences of smear tests. To the point many rape and sa survivors just don't bother.

My abuse "wasn't that bad" ie no penetration so I probably don't struggle as much as those who've been through worse.

Certainly in the last 10/15 years the nurses KNEW I was a survivor - still had people coming in unannounced.

The combination of feeling vulnerable, feeling like I'm going to fall off the bed, knowing it's going to hurt due to the endo plus I've a weirdly positioned cervix... All contributes to me absolutely dreading it. Last couple times I've taken diazepam an hour before.

"Incidentally, the neurotics and mitochondriacs don't seem to be such a problem for the systems abroad. So why should they be for the NHS?" Well exactly. There are problems with patients sometimes misusing services but then even us "neurotics" get actual, physical illnesses!

I havent read the whole of this thread but why on earth havent the NHS updated the backs of prescriptions to include Universal Credit.

People are getting fined even when ticking the box they have been told to tick.

Its been five years since UC was launched. FIVE YEARS.

Cynics are starting to believe that the NHS is in no hurry so they can keep charging these fines.

But if people cant afford their meds then they end up in A and E

Sometimes the NHS are their own worst enemy.

For once I haven't rtft. But OP you do understand that there are more than 24 countries in the world don't you? So when UK comes 20th that isn't really out of 24 countries in the last but out of over 200 countries in the world?

@tiggerkid i believe you

I lost 10 stone 16 years ago.. I got gallstones and it got so bad i couldnt eat SOLID food. i went through months and months of excrutiating pain and A + E admission. In and out of A + E for TEN MONTHS. then doctors coming to my home to give me morphine injections whenever i had an attack . Finally a doctor prescribed me morphine pills which melted under the tongue that i took every time i had an attack. First attack was 3 July 2002 Scan was on 19 Dec 2002 after months of A + E admissions . Early Feb 2003 i got a letter telling me id have to wait for ANOTHER YEAR. I cried my eyes out and actually considered suicide. It was only after a private consultation with a surgeon and then another admission to hospital and an NHS appointment with the same surgeon that my op was promised within 6 weeks It was done 5 weeks later on 28 April 2003.id lost 8 stone by the time i had my op. The surgeon and two doctors told me it was caused by losing weight too fast. (slimming world) The pain was excrutiating and the first attack appeared after id lost nearly 4 stone. Back then i had no idea fast weight loss could cause gallstones I was losing a stone a month and whenever i did try to slow it down i either stayed the same or gained.

I actually did seriously consider suicide especially after i got the letter telling me id have to wait ANOTHER YEAR. I thought it was beyond cruel especially when id lost the weight by myself with willpower.

i believe due to mixing tramadol with as many over the counter drugs as i could in the early months to stop the pain i have been left with long term issues and its also left a bitter taste in the mouth TBH. Im grateful for the NHS but i was in so much pain i was thinking of overdosing (which i was bloody close to anyway) i also think the fact i won Class Slimmer of the Year and started to appear in our local papers may have been a factor in me getting the op sooner than that awful letter said but i shall never know

And it can be life threatening.

www.telegraph.co.uk/news/uknews/10182112/Man-dies-after-999-operator-refuses-ambulance.html

www.dailymail.co.uk/news/article-2365464/Man-41-died-gallstones-begging-999-operator-GP-ambulance-told-bath.html

Haven't read the whole thread but worth pointing out that the NHS loses out sometimes because it collects more info. All hospitals here are compared to best/teaching hospitals elsewhere.

@MyOtherProfile do you understand how much the UK spends on the health care? This is why it is compared to countries that spend a comparable amount, or at least half (like Spain or Israel). It makes no sense to compare the UK to India and feel all cozy inside because you aren’t left to die on the street if you are stabbed

@theredjellybean

As a woman I can tell you that feel I want to go see a gynecologist when I have a health problem in that region because gynecologist is specially trained to recognize various diseases, and a gp isn’t. A special bonus of visiting a gynecologist in other countries (eg Israel) is that every gynecologists office, believe it or not, has a special machine, called the ultrasound which allows the doctor to SEE INSiDE YOU! This means that for example in early pregnancy if you have a bleeding he can rule out ectopic pregnancy by seeing an embryo in your uterus. This is just an example, this machine has many other uses that you certainly at least heard about as a gp (not sure if you ether used one?).

Getting such an appointment takes exactly two hours if you feel it’s an emergency (there are special clinics in every city). Or, you can get a regular appointment within two weeks to a month. For free. No gatekeeping. And somehow everyone is smart enough to navigate this system without the help from the GP.

Why cannot UK have something remotely similar? And all this threads on mumsnet where people talk about going to GP with their post-birth problems? To the GP even then, after essentially just being through an operation in many cases?

Sorry but in this area, the situation is simply shameful. There is no way to cover it with condescending over silly patients with their imaginary problems.

Much more effective gatekeeping can be achieved with just putting a small fee for seeing a specialist - with obvious extemption for those in need.

When DH had his heart attack in 2006 the care he got from the paramedics doctors , nurses and consultants was bloody top notch.

Eggplants...that was an incredibly patronising post.
On this thread many posters have clearly had bad experiences and if they feel their gp was negligent then I'd suggest they complain. Write to the phso or ccg or gmc if you feel your practice manager won't look into it properly. Though they should.
Your attitude is as bad as some of the GPS described by posters, none of which, if people bothered to read my posts, I have ever condoned or supported.
GPS spend years training, have a wide range of experience and often nowadays come from a different specialty first. I was an orthopedic consultant before becoming a gp for example so yes actually I do know a thing or two about patients knee pain or back pain.
GPS have to go through training in various specialties.. Obs and gynae is one of them.
Of course I don't know everything about gynae problems but I know a lot of the common stuff. If I don't know or can't work out what's going on then that's when a specialist comes in.
There is no doubt that some people would use direct access appropriately but my experience, which is seeing patients regularly and in large numbers, is the majority wouldn't and the whole system would collapse even further

Yes lots of cancers may not be attributable to lifestyle at the moment - predominantly those in older people, blood cancers and childhood cancers. That doesn’t really reflect that 79% of lung cancer is lifestyle choice, 26% of breast cancers are and 48% of bowel cancers are. Add in mouth and throat cancers, bladder cancer, pancreatic cancer and there’s an awful lot of money spent and misery for patients that didn’t need to happen.
Yes, of course people should take responsibility just as they should with obesity related diabetes and the need for hip replacements or alcohol related pancreatitis.
Why can’t GP have more gynaecologists? Because we don’t want to pay for them. U.K. spends much lower percentage of GDP on healthcare and less per capita. We don’t have that number and it takes at least ten to twelve years to train them.

On this thread many posters have clearly had bad experiences and if they feel their gp was negligent then I'd suggest they complain. Write to the phso or ccg or gmc if you feel your practice manager won't look into it properly. Though they should.

So what's your take on the frequent reports of people being struck off their GP list when they complain? Shouldn't there be "whistle blower" rights to protect people frightened of complaining?

that was an incredibly patronising post

Compared with the disdain and arrogance shown by theredjellybean in earlier posts, I'd say it was similar. You shouldn't give it out if you can't take it!

Why can’t GP have more gynaecologists? Because we don’t want to pay for them.

If people could self refer, you wouldn't need as many GPs. As said above, GPs have prior experience in specialist fields, so rather than converting to GPs, some could stay in those fields to increase the numbers in those areas. Simples. Just a matter of moving people around rather than needing more.

pancreatic cancer

Is another cancer without specific causes/triggers.

OK so you think it's OK to make specialists stay in fields they don't enjoy, doesn't work for their families etc... Really... Let's make all teachers who left come back shall we? Or nurses?
You talk about doctors as if we are a commodity owned by the public.
I left orthopaedics and trauma because I was suffering from ptsd after attending a very significant event. I could not go back to that ever...
Have you read the book 'sorry this is going to hurt' that doctor left the NHS due to bring made mentally unwell by the pressure and a catostrophic event in gynae... Going to make him come back are you?
Its unbelievablly naive to think we can manage with less GPS... Replace them with a few more gynae specialists... What about all the other stuff GPS do.. You'd lose all that.
I cannot see that I have been arrogant or patronising, I have merely replied pointing out the other side of the debate.. That is I do see how many people WOULD self refer to specialists with minor problems.

Oh and on the point of being struck off for complaining.. That's illegal and also a breach of good medical practice. Those people should complain to phso and their ccg.
It might be we are not getting the full story though

www.theguardian.com/society/2018/nov/15/exclusive-new-study-links-universal-credit-to-increased-suicide-risk?CMP=share_btn_tw

OP I completely agree. I cannot understand why so many people compare the US model either. Why can’t we compare to other efficient healthcare systems around the world.
I had a suspected mini stroke. I went to the nhs where my symptoms made the dr incredibly concerned, she told me, I’ll write you an urgent letter of referral now but I strongly suggest if you have private care you phone them up and see someone ASAP.

This country has such poor healthcare. I phone the doctors I need to wait 3 weeks until I can get a ridiculous hour app, ie last time they offered me 7am or nothing until 5 weeks. If I dared ask for a female doctor there was even less hope.
So many people harping in about how incredible our system is. I would like to know how many of these people have actually used a system abroad and realised there are better ways.