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Medical Forum / Diseases and Disorders / Breast Cancer / April 2005

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US/UK Difference

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Anthony - 15 Apr 2005 14:58 GMT
I'm reading a novel, "Is There Anything You Want" by Margaret Forster which
is set partly in a breast cancer hospital in the UK.I was surprised by this
passage
in which the doctor is seeing a new patient:

"She (the doctor) was taken aback to see not only a young woman on the bed,
but a man standing beside her, holding her hand.  It was against the rules.
These rules were not actually written down but they were always obeyed: only
the patient in the examining cubicle, unless special permission had been
requested and granted."

Here in the US a caregiver routinely accompanies the patient, and I wouldn't
dream of letting my wife see a doc alone for anything other than the most
routine check-up.  The doctors of course are used to this and I believe
welcome it (although perhaps they didn't to start with) because the
caregiver can be better than the patient at making sure that all the
questions are asked and answered and can be helpful when decisions must be
made.  My sense, both from the book and from comments in this and other
forums is that there is much more of a "doctor knows best" attitude in the
UK than here.
Mary Fisher - 15 Apr 2005 15:55 GMT
> I'm reading a novel, "Is There Anything You Want" by Margaret Forster
> which is set partly in a breast cancer hospital in the UK.I was surprised
[quoted text clipped - 16 lines]
> forums is that there is much more of a "doctor knows best" attitude in the
> UK than here.

I've never known of any occasion when my husband or anyone else I wanted
with me has been asked not to be there, with one exception. That was when my
children were being born in hospital forty years ago, things have changed
hugely since then. I've been with my daughter and daughters in law as well
as or instead of their husbands when they gave birth. These days siblings
and friends are often with women giving birth, it's regarded as the woman's
right to choose.

You said: "I wouldn't dream of letting my wife see a doc alone for anything
other than the most routine check-up" In UK please note that it would be the
wife's choice. The idea that a man wouldn't LET his wife see a doctor alone
is so old fashioned as to be laughable. We, men and women, are free to do
what they want in respect of medical attention - they can even object to
anyone else being present at a consultation no matter how important it is.
If we want someone with us we invite them.

Yesterday I was with a neighbour whose husband is dying in a nursing home.
The consultant asked to see the neighbour about her husband's condition and
care and discussed it freely with the neighbour and with me, without asking
who I was or my credentials. It was assumed that if the neighbour was happy
in my presence then there was no problem, my questions were answered as
freely as the wife's.

If you take your 'evidence' from novels you're never going to know the truth
of our culture. Goodness, if we believed USAian fiction we'd think you were
a different species!

As for what you read in forums, they are individual responses to individual
situations. Again, it's our choice to trust the doctors or to think that we
might know better. We choose a doctor and if we don't trust a doctor we
change him or her. But I think that most people don't assume that the doctor
is hiding anything. They have nothing to gain by doing so.

Mary
Anthony - 15 Apr 2005 16:22 GMT
> I've never known of any occasion when my husband or anyone else I wanted
> with me has been asked not to be there, with one exception. That was when
[quoted text clipped - 3 lines]
> siblings and friends are often with women giving birth, it's regarded as
> the woman's right to choose.

My children were born in the UK almost forty years ago, one in hospital and
one at home as was then the practice.  I was not present on either occasion;
to ask to do so would then have been seen as beyong eccentric!  The saying
then was "At a time like this a father's place is in his cups."

> You said: "I wouldn't dream of letting my wife see a doc alone for
> anything other than the most routine check-up" In UK please note that it
[quoted text clipped - 3 lines]
> even object to anyone else being present at a consultation no matter how
> important it is. If we want someone with us we invite them.

My phrasing may have been infelicitous, but I'm sure you know what I mean.
My wife is very pleased to have either me or one of our daughters accompany
her when she has an appointment, but if she didn't wish it of course we
wouldn't go.  It's never been an issue of any sort between us.

> Yesterday I was with a neighbour whose husband is dying in a nursing home.
> The consultant asked to see the neighbour about her husband's condition
[quoted text clipped - 6 lines]
> truth of our culture. Goodness, if we believed USAian fiction we'd think
> you were a different species!

I didn't use the word "evidence", I said my "sense" of the thing was thus
and so and obviously what I relayed was anecdotal.  That said, I'd be
surprised if a writer of Margaret Forster's standing had not done enough
homework to know what the practice is in hospitals in her homeland so that
she could accurately describe it in a book.

> As for what you read in forums, they are individual responses to
> individual situations. Again, it's our choice to trust the doctors or to
> think that we might know better. We choose a doctor and if we don't trust
> a doctor we change him or her. But I think that most people don't assume
> that the doctor is hiding anything. They have nothing to gain by doing so.

Doctor's may or may not hide stuff, but plenty of them are incompetent,
which is why second opinions are such a valuable tool, and I speak from
personal, first hand experience on this.
Mary Fisher - 15 Apr 2005 16:23 GMT
Why have you changed your name?
Anthony - 15 Apr 2005 16:29 GMT
> Why have you changed your name?

Changed my name?  Whatever do you mean?
A. P. Thorsen - 15 Apr 2005 19:46 GMT
> If you take your 'evidence' from novels you're never going to know the truth
> of our culture. Goodness, if we believed USAian fiction we'd think you were
> a different species!

Uh-oh, the truth is out!

We were hoping to keep the truth about the species thing from you UKians
by pretending to speak the same language.

Well, I'm off in my beemer, latte in hand, to get my monthly botox
injection and collagen lip-plump, before I go to an illicit liaison with
my best friend's husband, then head off to the inner city to pick up
some crack cocaine and get caught in a gang shoot-out.  Don't worry,
I'll just pull out my .45acp and defend myself so I live to let daddy's
lawyers set me up a tax shelter that will help me avoid taxes, spend the
money I got in a mutual fund scam on designer fashions and a new SUV,
and deny health care to the poor.

America is like that.  Honest.  Just like in the books.  Come visit.
You'll see. <G>

Ann T.
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Mary Fisher - 15 Apr 2005 20:11 GMT
>> If you take your 'evidence' from novels you're never going to know the
>> truth of our culture. Goodness, if we believed USAian fiction we'd think
[quoted text clipped - 4 lines]
> We were hoping to keep the truth about the species thing from you UKians
> by pretending to speak the same language.

but ... we don't <puzzled>

> Well, I'm off in my beemer,

BMW

> latte in hand,

coffee

> to get my monthly botox injection

Paralysing jab

> and collagen lip-plump,

Trout pout

> before I go to an illicit liaison with my best friend's husband,

adultery ... (unless "I'm" doing it when it's adventure)

> then head off to the inner city

Where I live

> to pick up some crack cocaine

Yep, where I live!

> and get caught in a gang shoot-out.

Not common where I live but it has happened.

> Don't worry, I'll just pull out my .45acp and defend myself so

Don't know where our rifle is ...

> I live to let daddy's lawyers

Solicitors (as well as lawyers - all crooks)

> set me up a tax shelter

Off shore fund

> that will help me avoid taxes,

Same in all languages

> spend the money I got in a mutual fund scam on designer fashions

Same in all languages :-(

> and a new SUV,

Sport Utility Vehicle

> and deny health care

Benefits

> to the poor.

under privileged.

> America is like that.  Honest.

I believe, I believe!

So we DO speak the same language. Well I never :-)

>  Just like in the books.  Come visit.

I'm waiting for a more precise invitation ...

> You'll see. <G>

I can't wait.

Mary
Pamela Cook - 15 Apr 2005 19:47 GMT
> > I'm reading a novel, "Is There Anything You Want" by Margaret Forster
> > which is set partly in a breast cancer hospital in the UK.I was surprised
[quoted text clipped - 53 lines]
>
> I was ging to post the very same things that you have put so well ,
mary... my husband is there with me at all times, at my invitation and would
respect my wishes if I wanted to go alone,  without question or query...
                  Pam xx
Mary Fisher - 15 Apr 2005 20:13 GMT
>> I was ging to post the very same things that you have put so well ,
> mary... my husband is there with me at all times, at my invitation and
> would
> respect my wishes if I wanted to go alone,  without question or query...
>                   Pam xx

Don't take it seriously, Pam, it's Lobby Ludd and I'm claiming my ?5.

Mary
Tim Jackson - 15 Apr 2005 17:22 GMT
> I'm reading a novel, "Is There Anything You Want" by Margaret Forster which
> is set partly in a breast cancer hospital in the UK.I was surprised by this
[quoted text clipped - 6 lines]
> the patient in the examining cubicle, unless special permission had been
> requested and granted."

A historical novel perhaps?

The only time I was ever refused permission to accompany my wife in
hospital was in the diagnostic x-ray suite, where it was explained that
due to lack of changing rooms they have several patients dressing and
undressing at the same time in the limited space and so they were
operating a single-sex policy in that room.

Which is about the same as being prevented from accompanying her into
the changing rooms in a dress shop.

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Anthony - 15 Apr 2005 17:31 GMT
> A historical novel perhaps?

No, it was published this year and the setting is contemporary.  It takes
place in the north of England, so maybe that has a bearing?
Mary Fisher - 15 Apr 2005 18:09 GMT
>> A historical novel perhaps?
>>
> No, it was published this year and the setting is contemporary.  It takes
> place in the north of England, so maybe that has a bearing?

LOL!
Tim Jackson - 16 Apr 2005 08:59 GMT
>>A historical novel perhaps?
>
> No, it was published this year and the setting is contemporary.  It takes
> place in the north of England, so maybe that has a bearing?

I take place there too.

The main cancer centre for the North of England is the Christie Hospital
in Manchester, which I know far too well, it seemed like a second home
for a while.  The staff were great, and very helpful.  Parking was a
pain though, the Hull experience mentioned elsewhere sounds somewhat easier.

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Mary Fisher - 16 Apr 2005 09:16 GMT
>>>A historical novel perhaps?
>>
>> No, it was published this year and the setting is contemporary.  It takes
>> place in the north of England, so maybe that has a bearing?
> I take place there too.

Me too!

> The main cancer centre for the North of England is the Christie Hospital
> in Manchester, which I know far too well, it seemed like a second home for
> a while.  The staff were great, and very helpful.  Parking was a pain
> though, the Hull experience mentioned elsewhere sounds somewhat easier.

The Yorkshire Cancer Centre is on the leafy outskirts of Leeds ... it also
serves the wider north of England :-) A wonderful hospital.

Sadly, it's going to be closed, all cancer services are going to be
transferred to St James'. The parking there (an enormous campus, the biggest
teaching hospital in Europe in built-up, crowded inner city Leeds) is
already all but impossible ... But the Powers That Be - our political
masters - have decided that it will save moneyand they'll be able to sell of
Cookridge for leisure, housing, hotel, conference centre or whatever and
that's far more important than the well being of patients.

I've no doubt that the facilities at St James' will be top notch but many of
us with experience of Cookridge will grieve.

Mary
alex - 15 Apr 2005 22:33 GMT
> Here in the US a caregiver routinely accompanies the patient, and I
> wouldn't dream of letting my wife see a doc alone for anything other than
> the most routine check-up.
Current practice, here in the US is to screen for domestic violence, You can
not ask the
question with a spouse present since having the offending spouse present
would not allow the
person to give an answer freely.
Mary Fisher - 16 Apr 2005 09:17 GMT
>> Here in the US a caregiver routinely accompanies the patient, and I
>> wouldn't dream of letting my wife see a doc alone for anything other than
>> the most routine check-up.
> Current practice, here in the US is to screen for domestic violence,

Do you mean as a matter of routine? That is, not just when there's a
complaint or suspicion?

Mary
alex - 16 Apr 2005 12:27 GMT
Use to be a only if had a suspicion, now it needs to be done, during an
annual exam, part of the screening, when they ask you about smoking, use of
guns in the home, use of seatbelts etc, Alex

>>> Here in the US a caregiver routinely accompanies the patient, and I
>>> wouldn't dream of letting my wife see a doc alone for anything other
[quoted text clipped - 5 lines]
>
> Mary
Mary Fisher - 16 Apr 2005 12:31 GMT
> Use to be a only if had a suspicion, now it needs to be done, during an
> annual exam, part of the screening, when they ask you about smoking, use
> of guns in the home, use of seatbelts etc, Alex

Good Heavens!

You mean Spouse would have to tell on me ? <BG>

Mary
A. P. Thorsen - 18 Apr 2005 17:09 GMT
> Use to be a only if had a suspicion, now it needs to be done, during an
> annual exam, part of the screening, when they ask you about smoking, use of
> guns in the home, use of seatbelts etc, Alex

Not routinely done here, IME (and I'm in the US).  They have signs up in
various places in the hospitals/doctor's offices, sort of soliciting
complaints if you need help.  And, I've been asked specifically when I
had visible though minor bruises.  (You can just imagine the kind of
attention you get when you practice martial arts, and tend to be very
suspiciously bruised!)

I can't recall any doctor asking me about guns (I'd be extremely
offended), or seatbelts.

Ann T.
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Sandy L - 16 Apr 2005 12:28 GMT
>>> Here in the US a caregiver routinely accompanies the patient, and I
>>> wouldn't dream of letting my wife see a doc alone for anything other
[quoted text clipped - 5 lines]
>
> Mary
That's particularly true of emergency departments and any sort of trauma.  I
don't know that questions would be asked of a woman seeing an internist for,
say, hay fever.
alex - 17 Apr 2005 05:04 GMT
My husband was asked these questions, about domestic violence when he went
for a colonoscopy. It is an expection that these issues are address during
an annual visit.

>>>> Here in the US a caregiver routinely accompanies the patient, and I
>>>> wouldn't dream of letting my wife see a doc alone for anything other
[quoted text clipped - 8 lines]
> I don't know that questions would be asked of a woman seeing an internist
> for, say, hay fever.
 
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