The Doctor Is In

Most people don’t get excited to take a visit to the doctor’s office.  I, however, considered it quite the opportunity.  Since I am a full time student in the UK, I am “entitled to National Health Service treatment” and was curious to see how treatment would vary from what I had previously received back home in the States.  This is by no means an official comparison of the systems, but I thought it would be interesting to share my first impressions.

To register, I took a 10 minute walk to my “local surgery” (the neighborhood clinic) and filled out  10-15 minutes worth of paperwork: name, address, have I previously registered with the NHS, have I received treatment in other countries, etc.   I turned it in and was told that it would take 24 hours for the paperwork to be processed, a requirement for making an appointment.

I phoned ~25 hours after submitting my paperwork and was delighted to hear that I was in their system AND that I could have an appointment the following afternoon.

Receptionist: We have 14:10, 15:40, or 15:50 available.

Me: 15:40, please, that fits in perfectly after class.

Receptionist: Ok, you’re all set.

Me: Oh… ok. Thanks… Um, did you need my chief complaint?

Receptionist: No, you’re all set.

I arrived for my appointment ~15 minutes early and took a seat in the waiting room.  This feels like home. 🙂 Someone from the surgery would open the door to the visiting rooms every 5-7 minutes and call a patient back. Almost exactly at 15:40, a young man (couldn’t have been more than 3-4 years old than me) in a button down shirt, dress trousers, and of course London approved supah-nice dress shoes opened the door and called my name.  Hyperaware of my polka dot wellies, I picked up my purse, walked over to him, and was directed toward the first room on the right.

Let’s pause for a second– a pretty good reenactment of my mild deer in headlights response.  This room to which I was being ushered appeared to be an office: large L-shaped desk with a supah-fancy office chair on the far side of the desk and a no-frills standard chair closer to us.  “Hello I’m Dr X,” he said as he pulled out the standard chair, offering me a seat.  I obliged. He walked around the desk, took a seat in the supah-fancy chair, and asked with a warm smile:

“How can I help you?”

Umm. This felt like an odd encounter with the Customer Service department. When I successfully pushed those associations out of my mind, flashbacks of uncomfortable interviews rushed in:  So, tell us about yourself, Andrea. What do you know already?  Do you want to know where I’m from?  About my family and childhood? The things that shaped me into who I am today?  My hobbies and interests?  My experience that may be beneficial for this position?  The reason I chose to apply?…

As a new patient, I was anticipating that there would be a medical history or basic physical exam incorporated into the visit, but perhaps he had read through my registration paperwork?? Dubious.  A significant portion of that registration medical history focused on which, if any, family members had been diagnosed and treated for high blood pressure, diabetes, or other high profile illnesses.

Umm.

I’m not sure what I had expected to happen in those few seconds of mind-overdrive, but when I finished my internal commentary, I was still uncertain how to answer the question. And he was still looking at me with a smile awaiting my answer.

“My lower back…” I offered cautiously, making sure I had started along the correct route before it was too late to turn back.  He nodded reassuringly, so I continued. After 3 minutes, I was given reassurance that I was taking care of myself in a reasonable manner.  He also provided me with a paper that had pictures of people demonstrating different back exercises (most of which I had already been doing) and gave me an opportunity to request a prescription.

me: For which medication?

GP: A pain medication.

me: Right. Which medication?

GP: A non-steroidal anti-inflammatory prescription drug.

me: I see…  (Unsure if he had intended for his answer to sound condescending, I opted out of describing ibuprofen as a non-steroidal anti-inflammatory over the counter drug.) And do you think I will respond any differently to it than I have been responding to ibuprofen?

GP: No, you’ll probably respond in the same way. You’ll just be able to purchase more than 32 X 200mg pills at a time.*, **

me: Ahh. I see. Well, then no thank you. I think I’ll stick with ibuprofen.

 

6 minutes after I entered the room, he bid me adieu.  Rx: continue self care, but complain more loudly to the facilities management about a better mattress (Student accommodations can be a bit dodgy sometimes.)

 

me: Oh, do I need to check out with reception?

GP: No, no. You’re all set.

me: Ok, well… (I guess that makes sense if there isn’t a chart or copay!) Thank you.

GP: You’re welcome.

 

*This was in reference to an exchange we had shared a minute earlier. Fun fact: in the UK, the max recommended daily dosage for ibuprofen is 1200mg as opposed to 2400mg in the US. You are also limited to buying 2 blister packs (where each pill is stored in it’s own individual foil compartment) with 16 pills X 200mg.  I’m no ibuprofen addict, but I wanted to buy a pack to keep in my purse, backpack, and desk… and was turned down.
**Although a prescription may have been more convenient, it certainly would have been more expensive.  Under the NHS, the flat rate would have been £8 compared with £0.32 per 16-pill OTC blister pack.

***

 Before any fights breakout, let me remind you that this is 1 anecdote.  Two points are required to make a line, and hundreds if not thousands of points are required to draw conclusions.

Rather than attempting to compare US vs UK health systems with very little data, I spent most of my reflection time this week thinking about the way this experience fits into what we have been discussing in my Foundations of Social Science, Health, and Medicine (FSSHM) class.

What is the significance of a the doctor-patient relationship? How is this relationship impacted by the length of the appointment? Or the arrangement of the clinical room? Or by (lack of) physical contact?  How is efficiency defined in medicine? By the number of people seen? Or the number people who receive care? How is care defined?…

I’m planning on shaping some of these questions into my FSSHM essay, so you will be hearing about this again.  In the mean time, I have two videos to recommend:

 

1. Wit

“A renowned professor is forced to reassess her life when she is diagnosed with terminal ovarian cancer” (IMDb).

My thoughts: A very moving story. Some aspects border on becoming a caricature, but as with any caricatures there is as aspect of truth to be seen.   I have experienced this type of “treatment” and I’m sure a number of you have as well.  It pains me to know that situations like this exist, but I find encouragement by interacting with physicians that actively fight this frightening stereotype.

Unique qualities: script features a lot of John Donne, 4th wall is broken (protagonist speaks directly to the viewer)

 

2. A Doctor’s Touch

“Modern medicine is in danger of losing a powerful, old-fashioned tool: human touch. Physician and writer Abraham Verghese describes our strange new world where patients are merely data points, and calls for a return to the traditional one-on-one physical exam” (TED).

My thoughts: An important video for any health care provider or patient.  Yes, that’s you.  If you’re short on time and have to choose one video, watch this (even at 1.5 speed if you have to!)

Many thanks to Dr Behrouzan (one of my FSSHM lecturers) and Zoe Walters (amazing friend and current pharmacy student) for recommending these to me!

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