Tuesday, 29 January 2008

Here's to Your National Health

"So, is this the National Health?" I asked the doctor.

"Well this is my little piece of the National Health," she answered.

"It's not what I expected," I said, putting my shoe back on.

"What did you expect?"

"Oh, I don't know. Screaming crowds of children in the waiting room. Cancer patients stacked up outside the door. Misery and anarchy. That sort of thing."

What I'd found instead was no waiting and an unhurried 20 minutes with a Scottish doctor who wasn't wearing a white coat.

For the last couple of weeks I've felt a pain in my right foot whenever I walk. It's like a hot fork plunged into my sole between the big and second toes. (Why a fork and not, say, a dagger? I don't know; it's just more fork-like.) It only hurts when I walk and it hurts most in the morning. I can poke and prod the foot and it's fine, even grab my toes and wrench them back and forth like I'm trying to tear off a hunk of crusty bread. Nothing. But walk on it and ouch!

I felt there might have been two causes: I'd taken up jogging again as part of the British Army Fitness Program printed in the Guardian. Although my knees usually go before my feet, maybe I'd done my foot an injury. Then there were my new shoes: I'd bought a pair of cheap yet fashionable slip-ons, somewhat pointy of toe, and with a sole about one micron thick. Then I spent the day walking around London in them. I basically walked until I couldn't walk anymore. It felt like someone had taken a tire iron to the bottom of my feet.

You think maybe that could have been the problem?

Whatever the cause, I was afraid I'd broken something. Aren't we taught that the human foot is a fragile assemblage of bones, each no thicker than a drinking straw? Might I have snapped one of these? I waded into the National Health.

My college here has a practice that it sends students to. I phoned the doctor's office to explain what was up, went in on Friday to fill out some paperwork and returned for my appointment yesterday. True to form, by this point my foot wasn't hurting nearly so much. It still seared in the morning but by the afternoon it was just a dull ache.

There was one young lady in the waiting room when I arrived but she was in and out in 10 minutes. The doctor called me in and listened as I described my symptoms. I always feel a bit of a fraud in situations such as this. I mean, people are getting their arms hacked off in Africa and my widdle footsie has a boo-boo. But the doctor showed no disgust. She examined my foot, asking if it hurt here or here or here. No, I said sheepishly.

I think in the States the doctor would have ordered an X-ray, a blood test and a full-body CAT scan. Instead, my National Health doctor diagnosed plantar fasciitis, demonstrated some stretches I should do and printed out a leaflet. She was going to prescribe a powerful anti-inflammatory but noted that it might interact with my heart medication and so decided against it. I'd just have to wait it out. If the pain wasn't better in a few weeks I should make another appointment.

And that was it. An altogether pleasant experience and no bill to pay. Of course, I might feel differently if I'd been denied some cutting-edge cancer treatment. (The local paper is full of such stories.) And if it turns out I do have a broken bone and my foot falls off in a week I'll be annoyed. (The doctor assured me there were no bones where it hurts.)

I have very good health insurance in America. It's also very expensive, paid for by my employer and by me. And as much as I'm glad that my children and I are covered, I can't help but feel a little guilty when thinking of all those children and parents who aren't.

The NHS doctor's waiting room was a typical assemblage of months-old magazines and children's books. I did notice one interesting thing on the wall: A review of the Michael Moore film "Sicko." Five stars the Guardian reviewer gave it.


Ken said...

I just knew they'd fob you off... Our GPs are designed to keep you away from the business end of medicine --- get back in there, demand a scan! You could be dying. What if it's gangrene?

Sarah Laurence Blog said...

We've been equally impressed by the National Health. No co-pays, no paper work and not even long waits. The doctors and nurses were helpful.

It wasn't so useful when I threw out my back. They don't refer to massage therapy or chiropractors etc. The young doctor explained that their medicine was more "Victorian."

I've heard not so good stories about national health dentists and most of those practices are full anyway.

However, the National Health did a top notch job on my husband's childhood heart surgery. They were even ahead of the USA.

National health coverage should be a top goal for any nation. Points to Hilary Clinton for that issue.

Hope your fit is feeling better soon! You can use ice as a substitute for anti-inflamatories. If you can't find ice here - a cold can of soda under your foot will work and buy better shoes.

mark from alexandria said...

It sounds like your GP might be in the right place on this. You should see if the "Runners' Repair Manual" is still in print. I remember it had great treatments for plantar fascitstis (sounds like a spring festival in Mussolini's Italy) and other common runner's feet issues. That said, buy some decent shoes! I know you can't go around London in your favorite New Balances without looking like an Ugly American tourist, but sometimes "needs must."

Candadai Tirumalai said...

CT and other modern technological developments can be enormously helpful but they are no substitute for a doctor's clinical acumen. William Osler, the renowned physician, who lived for many years in Oxford and who may be considered one of the founders of modern medicine, addressed this question in his books and lectures.
I had occasion to encounter the NHS at the point of more than routine care, which did entail considerable waiting periods.

William said...

Years ago, when we lived in Dubuque, our conservative to the bone, rock ribbed Republican pediatrician took off to practice the medical arts in Glasgow - some sort of exchange program. He came back a year later, still Republican, mind, but completely won over to the single payer, universal health care program. Essentially, he was thrilled to do what had gotten him into medicine in the first place: heal sick children and keep the healthy ones healthy.

My own experience with the NHS years ago in Oxford mirrors yours. Perhaps we are getting to the point in the USA where a national health plan becomes politically feasible. (But I am a dreamer)

PAB said...

Several years ago, my U.S. family was in London for my wedding. While there, my youngest brother developed a stomach ailment (too much English cuisine?) that required an ambulance ride and overnight stay at a hospital. One the day he was released, my parents nervously proffered their Visa card in anticipation of the enormous bill that was sure to come. To their surprise, they were told that my brother's treatment was NHS-covered and that there was no charge. It's a story straight out of "Sicko," and further evidence of the compassionate, comprehensive nature of healthcare coverage in Britain. The British approach is the correct approach.

Ken said...

Yep - our approach is a world-beater -- which, surely, is why the rest of the world is so keen to copy our version of central-planning meets rampant capitalism.

KTinDC said...

I was chatting with an American friend about our insurance situation here and the cost of it. "It's eight eighty a month," I said. She breathed in through her teeth and said, "Well, that's steep, but worth it for national coverage, I guess. What's that, $1600 US?" "Uh, no ... it's 8 pounds, 80 pence -- about 17 bucks a month." Not only that, for reasons I don't understand, my prescriptions are free because I have a thyroid situation. ALL prescriptions. I paid something like $70 of copays a month in the US.

Also love Sarah's comment about ice above -- worthy of a blog rant on its own. I laugh every time I order a diet coke with ice and get served the bottle with a highball glass containing one cube.

Richard said...


John's established that our houses are cold enough already. You want ice, Sarah? Chip it off the inside of the windows.


John Kelly said...

It's funny how my foot started hurting more just after I pushed the "publish" button on my blog. The placebo effect must have worn off.

I don't know the ins and outs of insurance reform in the U.S. but I bet the problem would be no one who already is happy with their doctor/medical experience would want to suffer any diminution in service. I wonder if too many people see it as a zero-sum game: For the poor to have coverage the rich will have to suffer.

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