Oh brave new world that has such doctors in it!

October 28, 2014 at 10:38 am | Posted in Uncategorized | Leave a comment
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NHS-LogoI’m a writer, and like many writers I’ve got what a friend of mine calls “text hunger” – if it’s there, I’ll read it. One such recent encounter was with one of those little leaflets that come with medicines.

Two things struck me about this text. The first, of course, was the bizarre range of symptoms I’d risk by taking the pills. Medicines by Big Pharma, side-effects by Goya. As it happened, I didn’t lapse into unconsciousness, my skin did not peel off and my eyes remained resolutely un-yellowed. (It was only a sinus infection!)

The second thing that struck me was the way the leaflet’s writers kept exhorting me to contact my doctor if I had any problems. As one of the side-effects was coma I’m not sure how they envisaged that scenario; but that’s by the by. I was left with the strong impression that wherever the writers lived, it was somewhere with truly amazing healthcare services.

The same impression seeps like a miasma of optimism from Internet sites about health-related issues. Any queries? Go talk to your physician, they’ll sort it out. Got a headache? (It could be a brain tumour!) Ask your GP; they’ll calmly steer you through your anxieties. Afraid your fever might be Ebola, not flu? Just get an appointment and check.

As for the frequent media reports of wonderful medical advances, with their tales of current patients carefully examined and lengthily treated, and future patients whose medications will be personalised to their particular circumstances, they seem designed to raise unrealistic expectations.

Where is this fabulous land in which doctors sit, primed and eager, in their surgeries, with all the time in creation to soothe, heal and most of all listen? It isn’t here. Nor, I suspect, is it where you are (though I’d be delighted to learn otherwise). Unrealistic? It’s like reading the Narnia books, except I’d be less surprised if I met a talking animal.

How does anyone think we are going to find the time and money to do all this personalising of medicine? Here in the UK we can barely afford the current NHS. Despite swallowing vast quantities of funding and research time, problems like obesity, alcoholism and dementia aren’t about to be ticked off the healthcare agenda. Medics may be able to do astonishing things like helping the paralysed to walk, but there are still an awful lot of common conditions – from arthritis to Alzheimer’s, chronic fatigue to Crohn’s disease – which they struggle to manage successfully, let alone cure.

Now and again the media, presumably tired of simulating Dr Pangloss, flips into attack mode and screams about hospitals in special measures and patients expiring for lack of medical attention. We have those round here too: a ring of hospitals so poorly that we can only pray we never get sick enough to need them. But over-emphasising the negative is no more helpful than dishing out happy positives. When a friend of mine needed urgent care, it was given with quick and kind efficiency.

Plus or minus, public visions of the NHS seem worryingly detached from the reality. I heard a top doctor on the news the other day fretting about how paying doctors to diagnose dementia could affect the doctor-patient relationship. What relationship would that be? Every time I visit my surgery I see a different person. They are almost all kind and pleasant, but they have a demoralising aura of hurry and overwork, as if patients are not so much people as problems to be solved, with a pill if possible or a referral if not.

Our GPs are so busy that same-day appointments are a rare treat. This may be because they are currently overwhelmed by people panicking about Ebola, as a friend sourly suggested, but I doubt it. The NHS I know – the real one, not the media fable – has had these problems for years. All those siren voices encouraging people to book appointments may not have helped, but the problems run deeper than mere anxiety.

Moreover, not everyone panics. There are many patients who, like me, ruinously distort their nation’s health statistics by not going near a doctor unless they’re driven there by nagging friends and relatives. A cold or flu? Pile on the painkillers, whip up a honey-and-lemon. Lingering coughs and strange twinges? Wait a week or two and see if they get any worse. I had my sinus infection for months before I bothered the doctor with it, and that was only because I was getting so deaf it was making conversations difficult.

When I did finally approach the surgery, there wasn’t a hope of actually seeing a doctor that week. I managed to get a prescription purely by telephone, from a complete stranger whose scheduled morning call was three hours late. The consultation may have lasted as much as five minutes. And the pills didn’t work, so I had to go back again.

This is the real NHS: good people doing their best in near-impossible situations. They can fix many basics. There’s a huge amount they can’t fix, because medicine just isn’t that accomplished yet.

But it’s not just that. Patients and future patients ramp up the problems by smoking, overeating, drinking too much, sitting around all day and/or refusing to take responsibility for their own health. That’s you and me both, and the world and his wife or partner, egged on by the media, politicians and various industries whose business models depend on our laziness, greed, short-termism and anxiety.

Why is it so difficult for people in the public eye – politicians, doctors, media commentators – to say so? Why the polished pangloss or the exaggerated panic? The NHS has enough to deal with without these crazed swings from love to hate, from praise to vituperation. And those of us who see the NHS as a national treasure need to think clearly about its needs, which are our needs – especially with a general election looming.

How can we do that if no one will tell us the truth, unvarnished, untarnished and without obfuscation and propaganda? I know humankind cannot bear very much reality (Mr Eliot said that, so it must be true). But surely we could bear a little more than this.

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