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Medical Forum / Diseases and Disorders / Prostate Cancer / January 2007National Health Systems
Originally in alt.support.arthritis > Montreal. She has tried to get a new Primary for > nearly 3 years when she finally got this one. I > hadn't realized it was that bad, but apparently > the current docs aren't taking new patients, new > ones are coming in, and some specialists are now > on strike (or were a couple of weeks back). It is getting bad. I am in Perth, near Ottawa. One of our doctors just retired leaving 3,500 patients without a doctor. We have others nearing retirement age. My beef if that the CMA won't allow foreign doctors to qualify to work here. There are doctors driving taxis, working as lab techs and all kinds of things. I agree not all are up to par, but spend 6 months or a year with a GP and get to know the system here, make sure the language is up to par. And then the med schools cut the enrollment. We used to have a top notch medical system. I don't know the Montreal docs so can't help your friend there. I am lucky to have a great RD in Kingston. An hour drive to see him, but he's worth it. Joan ___ Blue Wave/QWK v2.12 > ... I am lucky to have a great RD in > Kingston. An hour drive to see him, but he's worth it. > Joan How can you drive for an hour if you're ill? Mary > How can you drive for an hour if you're ill? A cancer patient can't drive an hour to a doctor appointment? A person with arthritis can't drive an hour to a doctor appointment? I was diagnosed with ankylosing spondylitis in 1976 and drove, sometimes for 4 - 6 hours, until 1996. >> How can you drive for an hour if you're ill? > [quoted text clipped - 7 lines] > 1976 and drove, sometimes for 4 - 6 hours, > until 1996. Reminds me of the ER doc's escalating expressions (plural) when I made each of these statements near midnight: Yes, I drove 140 miles through twisty mountain roads with a broken collarbone. Yes, on Percodan. Yes, it was a stick shift. Yes, it IS, TOO broken. (off go the shoulder pads to reveal an OBVIOUS fracture.) You gotta do what you gotta do. I.P. >>> How can you drive for an hour if you're ill? >> [quoted text clipped - 18 lines] > > You gotta do what you gotta do. Well, I wasn't thinking of routine cancer appointments but I can think of some illnesses which would prevent driving for an hour. And driving with broken bones or some drugs would be an offence here if an accident occurred. Don't doctors do house calls? Mary > I.P. > Well, I wasn't thinking of routine cancer appointments but I can think of > some illnesses which would prevent driving for an hour. And driving with > broken bones or some drugs would be an offence here if an accident > occurred. > > Don't doctors do house calls? Don't we wish. Do they in your system? When I was a child, house calls were done by most family physicians. There is a little movement back now in this direction among doctors who care for elderly patients. I think the problem here is two-fold. The cynical would say that it is not cost-effective for doctors who can make more in fees by seeing more patients in their office. While this may be a part of the reason for some doctors, I think more important reasons are that the good family physicians have very large practices and just wouldnt have the time to make house calls, and they can treat more effectively in their offices where they have supplies and equipment available. >> Well, I wasn't thinking of routine cancer appointments but I can think of >> some illnesses which would prevent driving for an hour. And driving with [quoted text clipped - 4 lines] > >Don't we wish. Do they in your system. The last time I recall was in 1949. If Mary's getting house calls she must be baking some exceptional scones. >>> Well, I wasn't thinking of routine cancer appointments but I can think >>> of [quoted text clipped - 8 lines] > The last time I recall was in 1949. If Mary's getting house calls she > must be baking some exceptional scones. It's been a long time since we needed a house call - apart from the district nurse. But a few weeks ago I spoke to the duty doctor and he offered to come, the following week another did - without our asking. We said we didn't need it, just talking to them was enough to reassure us. That's another service - if we don't need to see a doctor we can arrange for a telephone interview (mine weren't arranged). The receptionist offers certain times and our chosen doctor rings the patient at that time. Ten minutes are allowed but usually it doesn't take as long as that. If might be for results of an x-ray for instance. Other results, such as cervical scans, are informed by letter. Also, our practice has a suggestion box and responds to what patients have to say. I couldn't bear the waiting room door being left open or banged by patients, I suggested an automatic door closure and it happened. There will be different services offered by different practices in other areas, I can only speak for the practice we belong to. Mary >>>> Well, I wasn't thinking of routine cancer appointments but I can think >>>> of [quoted text clipped - 29 lines] > > Mary I'd like to affiliate with your practise. Unfortunately I'm a wee bit out of the boundaries. >> Well, I wasn't thinking of routine cancer appointments but I can think of >> some illnesses which would prevent driving for an hour. And driving with [quoted text clipped - 4 lines] > > Don't we wish. Do they in your system? Yes, if you're too ill to make it to the surgery. Our practice is at the bottom of the street, by the way. We make appointments usually but there's a 'duty doctor' who will answer emergencies during the day, no appointment is necessary for that. If you have a minor injury which doesn't need hospital emergency treatment you can go to the practice to be seen by one of the nurses. When the practice is closed (at night, weekends or holidays) and you need to see a doctor urgently you telephone your practice and a duty doctor will attend to you. If a GP prescribes a medicine or appliance you can get it at a local pharmacy or a 24 hour one, in an emergency, there's a local rota. for repeat prescriptions you take your 'repeat prescription' to the practice and collect the signed script two days later, in our practice. If you need it immediately (for instance if you're called from home and will run out of something while you're away) it can be signed immediately. No doubt these systems are open to abuse but I suspect that a patient will only try it once! > When I was a child, house calls were done by most family physicians. > There is a little movement back now in this direction among doctors who > care for elderly patients. Yes, it's mostly very young children or older patients who need house calls but there are other acute illnesses which need treatment. Of course some sudden onset illness - such as heart attack or stroke, need the ambulance service which will come with the essential equipment and paramedics to operate it until the patient can be taken to hospital. > I think the problem here is two-fold. The cynical would say that it is > not cost-effective for doctors who can make more in fees by seeing more [quoted text clipped - 3 lines] > make house calls, and they can treat more effectively in their offices > where they have supplies and equipment available. Our practice is very popular and many people would like to be on the list. When the practice was formed there was a geographical intake, a bit like a parish boundary. The practice is allowed a certain amount of funding. Our practice is run as a 'democratic co-operative', that sounds very hippy but it's not! The staff do meet regularly for training and discussion of aims and objectives. At one of these they decided not to accept a salary rise but to put the money into better patient care. This is all within the National Health Service but a practice has a lot of say in how its allocation of money is spent. That's one reason we can have house calls, say for a child with a sudden temperature rise and who is in pain. It would be inappropriate for the patient, the parent and other patients in the waiting room for that child to be taken to the practice. Since our practice doctors have a local policy they can see a patient in his own house and be back for the next patient in a short time. By the way, we have several doctors in the practice, all GPS but all with one or more specialisms. I prefer to see a certain one for most things but would be happy to see another if he weren't available. But if I presented with something for which another of the partners has an interest in I'll be asked if I want to be seen by him/her. A close friend of mine dislikes 'my' doctor but is happy with one I have no time for :-) Incidentally I live - and the practice is in - one of the immigrant areas of our city. There is a black doctor and a middle eastern one, a mixture of nurses and, of course, sexes. But I've noticed that patients' favoured doctors don't correlate to their own race/colour/country of birth/sex. There's always a political move to get a bigger range of races and sexes in practices so that they're 'representing the population'. Well, the patients don't seem to care about that :-) And to represent our local population you'd need more than forty different language speakers - of each sex LOL! The politically correct people should come to see what happens in real situations before spouting about principles. Sorry - I've gone way off topic. Smack hand! Mary >>> Well, I wasn't thinking of routine cancer appointments but I can think >>> of some illnesses which would prevent driving for an hour. And driving [quoted text clipped - 78 lines] > > Mary so then...you don't *do* scones ???? ... >> Sorry - I've gone way off topic. Smack hand! >> >> Mary >> > so then...you don't *do* scones ???? Well ... er ... can I trust you ... ... are you a doctor ... ? <VBG> Mary who's been observed on a bread group by a lurker, apparently! > The politically correct people should come to see what happens in real > situations before spouting about principles. > > Sorry - I've gone way off topic. Smack hand! > > Mary ~~~~~~~~~~~~~~~~~~~~~~~~~ Mary's view of the National Health Service in GB is a very personal one, and one written from the perspective of an urban resident living in a densely populated area. Rural GB's National Health Service has been wrecked by Tony Blair - better known at Tony B_liar - a supposed Left-wing Socialist whose best[only?] friend is George Bush, a right-wing Republican . . go figure! I live in a deeply rural area: we have to drive - we have no public transport at all - to our GP's Surgery["office" in the USA], which is eight miles away. Our nearest Accident & Emergency services ["ER"] are 28 miles away in one of two directions, in hospitals which are bursting at the seams, in a poor state, staffed with nurses and doctors whose morale is at an all-time low. The National Health Service is good if you live in an urban area, it is good in most places if you need to scraped off the blacktop after a road traffic accident and re-assembled, but for routine medicine it tends to be a "one size fits all" affair, with restrictions placed on treatments and drugs. If you happen to be the right size for that hospital, then you will [hopefully] be well cared for, care for which you have paid in advance via direct and indirect taxes. Start talking about the most recent developments in treatment and outside the superb Teaching Hospitals attached to the major universities and you will struggle and likely as not be denied anything other than the basic treatment. HIFU is readily available in the private sector but is still "being tested" in NHS hospitals - which is a method the NHS uses to ration new treatment. The newer radiotherapies are not generally available, attributed to "capital costs". Drugs are rationed in the same way, while the controlling body, The National Inst for Clinical Excellence, "reviews and tests" them . . they take a very long time over expensive drugs oddly enough. As to GPs . . well there are good and bad everywhere . . but for most of the population, and in particular in many rural areas, the service they provide gets poorer and poorer as the Drs' salaries rise higher and higher and they offer only a bare minimum Out Of Hours service, delivered often by locum drs. via a contracting agency. The GPs themselves contractually work 08.30hrs till 18.30hrs Mon-Friday when they are "responsible" for the people on their lists. Rural Britain' services in many fields, not just the NHS have been sacrificed by B_liar's government in order to buy votes from the urban areas and the National Health Service is frequently in a lamentable state, a state which contrasts with the service offered in deprived inner-city areas, and a service which is often very, very poor when contrasted with kinds of medicine practised in the private sector in London, where some of the very finest clinics in the world offer the very finest medical services to the wealthy who fly in for top-class treatment as well as the luxury services offered. Rural areas have different needs, delivered in a way quite different to the needs of urban populations and B_liar's government has ignored them. As a Brit with an American-born wife and friends in the USA, I know the NHS well and I am not un-familiar with Drs and medicine, on a second-hand basis, in the USA and I know that for those who can buy medical insurance cover by whatever means or as part of their salary arrangements, medicine in the US tends to offer choice and skill. I also know that for the poorer and more vulnerable members of Society, then in GB they are better provided for . . and I am happy to pay my huge taxes for a system which does not leave the sick wondering if they can afford treatment: it offers a safety net which is virtually 100% safe for all. But I also know my wife and I find ourselves paying a second time to get better treatment often or treatment delivered in the way we prefer in an environment which is conducive to being relaxed and comfortable. PM >> Well, I wasn't thinking of routine cancer appointments but I can think of >> some illnesses which would prevent driving for an hour. And driving with >> broken bones or some drugs would be an offence here if an accident >> occurred. Certainly I was at legal risk, and was probably impaired by the Percodan, but the alternative was to just sit there in pain in the remote desert overnight; there probably wasn't a man-made structure within tens of miles. The doc insisted I tell him who gave me Percodan illegally (it's a prescription narcotic), but I wasn't about to tell him. >> Don't doctors do house calls? Most doctor visits run maybe 5-10 minutes, and some require on-the-spot medical tests. Think they're going to add an hour's travel time and have no X-ray machine or blood test lab handy? And much of my life has been spent in remote locations engaged in what some people would call extreme sports; we're on our own. One lady virtually died twice while distant ambulance services argued over jurisdiction; we finally had to call in an air evac helicopter to save her life. Rules and regs don't work everywhere. I.P. |
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