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American using Britain’s NHS (2015)

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Re: American using Britain’s NHS (2015)

#51

Post by IanCal »

Havoc wrote: post #49

>In the US, having sat in many an ER waiting room for hours at a stretch, the idea of a hospital seeing nearly 9 out of 10 patients in four hours would be regarded as a miracle. That is so bizarre. I'd be concerned if it takes and hour. Seriously it's called emergency room because it's an emergency, not a "it can totally wait" room.

Rather depends who is there and why. Last time I went was for a small animal bite (had gone to the docs but they had no tetanus shots so sent me on), hardly life and death. Was triaged quickly, but then waited to be dealt with properly.

Re: American using Britain’s NHS (2015)

#52

Post by sambe »

arseraptor wrote: post #25
sambe wrote: post #24

I have never seen such a bureaucratic/inefficiently operated institution - and there are plenty to choose from in the UK. My electricity company replaced all Vs with Ks in letters to us for 7 months. The NHS is much worse (try even getting a letter to arrive within a month - to the right address - let alone receive any medical treatment). I have not dealt with US healthcare but having experienced other countries' I'd…

Funny how your anecdotal point is just that, anecdotal. Here's another anecdotal point for you -- Pancreatic cancer (stage 2). Diagnosed on the first visit even though a private doctor had missed it previously. Surgery in less than 5 days, excellent follow-up and post-surgery care including the surgeon having a set of non-mandatory procedures approved in record time (10mins) as a preventative step towards recurrence.…

I didn't claim otherwise - is there a need for that tone? What have private GPs got to do with it?

I don't doubt that the NHS would treat me reasonably quickly and probably quite well if I had stage 2 cancer. People in the UK have been trained to herald such as a result as heroics from the NHS, as if the alternative was third-world level service. I do expect - based on a lifetime of anecdotal data from myself, friends and family - that the whole process would reveal repeated mistakes, bureaucracy and time and money wasted. False dichotomy often prevails in NHS discussions.

Re: American using Britain’s NHS (2015)

#53

Post by jdietrich »

Scoundreller wrote: post #36
jdietrich wrote: post #28

Earlier quoted context omitted.

The former. Access to the majority of non-emergency care is gatewayed via your GP (primary care physician/family doctor) - if you need to see a specialist, you can only do so by asking your GP for a referral. You'll then wait weeks or months to see a specialist, although you may be sent for tests before then. We have a chronic shortage of GPs and the system as a whole is severely underfunded, meaning that many people…

> Some GP practices have reduced the strain by offering appointments with Nurse Practitioners, who can treat common and uncomplicated conditions. This solution is far from perfect, because there's a lot that Nurse Practitioners can't treat. Are the NPs not permitted to treat these other conditions, or incapable? I fear there's a turf war between GPs and NPs, where GPs are worried about losing bread-and-butter work th…

>Are the NPs not permitted to treat these other conditions, or incapable?

Both. They're cheaper because they've received much less training than a GP. We could allow them to treat a wider range of conditions, but there would be serious patient safety implications.

The use of nurse practitioners in primary care is relatively new and we don't have a lot of good-quality evidence on patient outcomes, so it's reasonable to act with some caution until we have better evidence. Even in their current role, they could be missing significant clinical issues that a doctor would have spotted - we just don't know at this stage. The concern isn't about the 99% of patients who have something mundane, but the 1% of patients who have something that looks mundane but is actually very serious.

There's undoubtedly some amount of territoriality on the part of doctors, but at the moment everyone is just desperately trying to cope with demand. There seems to be fairly good esprit de corps throughout the NHS, with practitioners at all levels uniting around the need to maintain good patient care against the common enemy of Jeremy Hunt.

Re: American using Britain’s NHS (2015)

#54

Post by chrisseaton »

blibble wrote: post #40
simonbarker87 wrote: post #38

By comparative metrics to the rest of the world the NHS comes out either top or pretty damn good. By comparison to whatever the metrics of whatever government is in power at the time the NHS always looks terrible. Budgets can be set arbitrarily by the government so it’s easy to make the NHS look like it is over budget (in fact all you need to do is increase the budget by less than inflation and talk about absolute nu…

> The whole “4 hour” thing is mad - you should be seen in a reasonable time frame for the ailment you have. Severed hand? Go right ahead. it's already like this, A&E is run on triage, "4 hours" is a target not an instruction and if you go to A&E with something like a cold you'll be given a stern talking to and sent home

> you'll be given a stern talking to and sent home

Yes and then sometimes that person dies as the recent case in the news about the girl with asthma who was told off for being late and sent home to die.

The NHS’s matronly they-know-better is a real problem of an effective state monopoly on healthcare. You can’t complain or take your business elsewhere. If they tell you to go home that’s it and there’s no other option.

Re: American using Britain’s NHS (2015)

#55

Post by pjc50 »

Note that the UK also has a small private system; if you're really not happy with waiting for appointments or operations you can pay to be seen. Some higher-paid jobs come with health insurance, which is really cheap because anything difficult or expensive can be shunted off to the NHS.

Re: American using Britain’s NHS (2015)

#56

Post by Scoundreller »

lavrov wrote: post #14
triviatise wrote: post #4

one of the meta challenges with socialized medicine is that there is virtually no innovation due to price controls (please no anecdotes). The US essentially funds medical innovation for the entire rest of the world. If the US goes socialized you will see almost a complete halt to medical innovation over time. Here are 3 (not evidence based) reasons why medical care costs more in the US: 1) more administration (too ma…

The argument that "if the US goes socialized, you will see almost a complete halt to medical innovation over time," and therefore that private funding of research is preferred, is a bad one. It rests on the premise that the profit motive for pharma companies and the imperative to improve health care outcomes for the greatest number of people are aligned, which they are not. Public funding of drug research is a better…

On the other hand, streams of interesting new oral Type-2 diabetes medications have been coming out. E.g. Gliptins and gliflozins

Unfortunately, Alzheimer's and Parkinson's treatments have been a black-hole for research funding. Many have tried, most have failed.

Re: American using Britain’s NHS (2015)

#57

Post by sambe »

strawcomb wrote: post #30
sambe wrote: post #24

I have never seen such a bureaucratic/inefficiently operated institution - and there are plenty to choose from in the UK. My electricity company replaced all Vs with Ks in letters to us for 7 months. The NHS is much worse (try even getting a letter to arrive within a month - to the right address - let alone receive any medical treatment). I have not dealt with US healthcare but having experienced other countries' I'd…

It's actually one of the best value health care systems.. Sadly it is being made inefficient by the current government. If we are going by anecdotal evidence, the NHS has been absolutely brilliant for me. https://www.theguardian.com/society/2017/jul/14/nhs-holds-on...

Oh come on, it's always fashionable to blame the current government. The Guardian's view (which has shifted further left and become more "us vs them" divisive in the last couple of years) of an already unpopular Conservative government is not the first source I'd used.

Personally, I've seen these reports come up from time to time, and having experienced some of the other countries listed find it very hard to believe. It sounds like a lot of the data is collected from patient surveys. My claim that citizens have a positive-skewed view of the system is relevant (I recently read a survey result where UK citizens considered the NHS a greater achievement than defeating the Nazis and the abolition of slavery).

Re: American using Britain’s NHS (2015)

#58

Post by dazc »

Havoc wrote: post #49

>In the US, having sat in many an ER waiting room for hours at a stretch, the idea of a hospital seeing nearly 9 out of 10 patients in four hours would be regarded as a miracle. That is so bizarre. I'd be concerned if it takes and hour. Seriously it's called emergency room because it's an emergency, not a "it can totally wait" room.

A lot of patients are anything but emergencies though. Since it can be near impossible to get a same-day doctors appointment in some areas. In the South of England it can be weeks.

So people just go to the hospital A&E dept instead, sometimes for quite minor ailments - although not always.

Re: American using Britain’s NHS (2015)

#59

Post by 77pt77 »

sambe wrote: post #24

I have never seen such a bureaucratic/inefficiently operated institution - and there are plenty to choose from in the UK. My electricity company replaced all Vs with Ks in letters to us for 7 months. The NHS is much worse (try even getting a letter to arrive within a month - to the right address - let alone receive any medical treatment). I have not dealt with US healthcare but having experienced other countries' I'd…

> My electricity company replaced all Vs with Ks in letters to us for 7 months

What does that mean?

Re: American using Britain’s NHS (2015)

#60

Post by cjrp »

chrisseaton wrote: post #54
blibble wrote: post #40

Earlier quoted context omitted.

> The whole “4 hour” thing is mad - you should be seen in a reasonable time frame for the ailment you have. Severed hand? Go right ahead. it's already like this, A&E is run on triage, "4 hours" is a target not an instruction and if you go to A&E with something like a cold you'll be given a stern talking to and sent home

> you'll be given a stern talking to and sent home Yes and then sometimes that person dies as the recent case in the news about the girl with asthma who was told off for being late and sent home to die. The NHS’s matronly they-know-better is a real problem of an effective state monopoly on healthcare. You can’t complain or take your business elsewhere. If they tell you to go home that’s it and there’s no other option…

> If they tell you to go home that’s it and there’s no other option.

Not even remotely true, if you don't mind paying. You can see a GP privately, there are already lots of apps which let you book appointments. A colleague had an ear problem, couldn't get an appointment with his local GP and so used one of these app-based services and got a same-day appointment with a doctor near the office.

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