Abuse of the NHS

I see the NHS has been coming under some scrutiny this past week or so, mainly from politicians in the US. This seems to be because Obama's administration is currently trying to pass through new health care reforms aimed at providing medical cover to the entire population and not just those who have private insurance. As the debates rage on, the NHS has been put up as an example of how to do it rightly and wrongly depending on what side of the argument you stand on.

Last week a Tory MEP, Daniel Hannan on US television, much to the delight of Republicans, labelled the NHS as a "60-year mistake" saying that "he wouldn't wish it on anyone." This has understandably and rightly led to criticism from various politicians including the Prime Minister and Health Secretary who has labelled Hannan's words as "unpatriotic" and as "an insult" to the 1.4million workers in the NHS - including me.

Am I insulted? No, not really. I don't agree with Hannan's opinions nor do I find them particularly helpful, but I am not insulted by them. Like all large organisations, especially government funded, the NHS is not perfect, it has some major flaws and issues which need improvement (in some cases drastic improvement), but as a form of health care I believe it is a far better service than what is available in the US.

Interestingly Hannan has previously made some suggestions about how to improve or adjust the NHS, but they have all been ignored and overshadowed by the comments he made in the US. Obviously taking things out of context and being attacked by opposing party politicians is standard fare these days so it's no surprise about the reaction Hannan as recieved in light of these comments, but it does highlight how sensitive a topic the NHS is and will remain to be.

The main issue with the NHS is it's role as a universal health care system for everyone. Everyone is entitled to free health care but the quality of care varies with each condition. Studies have shown how the NHS fares in dealing with certain conditions compared to other Western countries and it seems that it struggles to match the success of other countries. For example in Britian, males have a 51% 5-year cancer survival rate, compared to 57% in Finland and Switzerland. Similarly in care for patients with heart disease or strokes, the figures show that the NHS continues to lag behind our European neighbours.

However, looking at pure statistics ignores the main concept of the NHS - I feel that it is the universal aspect of the NHS which is it's main problem. No other country has a health care similar to the NHS - the idea of it being completely funded by the taxpayer for everyone is unique. I believe that this is the main cause of it's struggles and failures.

In my experience (of 5 long years), people's attitudes towards their health is derived from the NHS. Because care is free, people are more lax and carefree towards their health. The majority of patients I see are so dumb when it comes to their health. I'm not just talking about the un-educated or working class, I'm talking about lawyers, accountants, bankers (although maybe they're just generally dumb) and other professionals. They just appear to have no idea about what to do and what not to do about their general health. Today, the health costs are huge to look after people who have problems related to alcohol, drugs, smoking and diet and most of them do not care. The care is free so they'll carry on abusing themselves.

I have repeatedly asked patients about what they should be doing to improve their health and am repeatedly met with blank expressions, offering no suggestions. People are not interested. Instead of a doctor-patient relationship, it often feels like a parent-child or teacher-student relationship, although in this case the child/student doesn't seem to learn, they just carry on as before. Of course, I am generalising, but the impression that I have built with my experience is that of a population that is not all that bothered about their health. Is it any surprise then that our survival rates are so poor?

In other countries where there is a mixture of government funded and privately funded health care, the care is better. Perhaps it's because people care about themselves. Of course there will be patients who suffer from alcohol abuse, smoking etc, but I don't think it's as bad as it is here in the UK. I've mentioned this before, but offer something free and inevitably it will be abused. The NHS is being abused.

I've discussed the options of charging for health care before and I am not going to head down that path again, but there has to be some repercussions for not looking after yourself after you have been given the necessary and correct advice from your doctor or health professional. It is arguably the most infuriating aspect of my work - seeing patients repeatedly for the same problem mainly because they refuse to help themselves. They keep turning up expecting solutions, when the main solution is to improve themselves and change their practices.

I leave you with an example from this morning's surgery. I saw a 20 year old female who keeps presenting with recurrent abdominal pain for the past 5 months. She is overweight, has a poor diet, takes recreational drugs and is currently unemployed. She has never tried to modify her diet ("it's too difficult") nor has she undertaken any exercise ("I don't have the time"). On her notes are clear documentations of plans other doctors have suggested to her to try and improve her symptoms and she has barely followed any of them. Because health care is free, she has had investigations including an ultrasound scan and various blood tests, all of which have been normal and yet she keeps coming back expecting us to have a quick-fix for her that doesn't require her to make any serious or strenuous modifications. I am afraid it just doesn't work like that.

Before people complain that she probably has psychological issues and can't change herself even though she wants to etc. First of all in this case it isn't true, I've asked, secondly, if that was the case she would still be able to get the psychological help, but I doubt it would make any difference and finally, do you not think there would be a change in attitude if there was some sort of repercussion for not looking after herself, or for not taking the necessary advice? I think there would be.

In the end, many improvements are needed in the NHS, of that there is no doubt, but one of them is to place more onus and responsibility on the patients who the NHS serves. Stop placing all the blame on the NHS itself and perhaps start focusing on the people who continue to take advantage of it - the patients.

Take care all,
Thoughts just flow, when do they have to make sense?