Today I had another example of how dysfunctional our semi-socialist health care system is: I visited my doctor.
What's wrong with me is that I have a tacky throat and a bad taste in my mouth. I've had it for about a week (at least it's been bothering me that long). Today is worse in that it feels like something is trickling down the back of my throat accompanied by a slight (I emphasise the slight) sickly feeling.
The doctor was pretty much completely uninterested in my symptoms checking quickly to make sure I didn't have swollen glands, spots, or a temperature. At this point - bereft of an opportunity to prescribe me an antibiotic - he declared his interest in the matter closed and offered me a referral to an ear, nose, and throat specialist.
What choice did I have but to agree? And because I don't have private medical insurance I will be waiting for a month or more (although if it gets worse - by which I assume he means that I develop an infection he can treat with antiobiotics - I can come back).
I tried to engage the doctor in a discussion of my symptoms and possible causes but he was unmoved. When I suggested I couldn't be the first person to arrive in a doctors surgery with a sticky throat and bad taste in my mouth he said I was the first he'd come across. But this didn't provoke any interest. For him there was no mystery to solve and he obviously felt he'd discharged his duty in referring me on.
Now this is not the worst encounter I've had with a doctor. But it was unsatisfactory and, as I left, I made a mental note to ask for a different doctor next time. I also mused that I would certainly have been unhappy paying for such a consultation.
But then I didn't pay him. He got paid by someone else: central government, the local health authority, the trust, I don't know. But someone paid him for that experience (I wonder how much?) But whoever paid him has no idea of the outcome for me -- why don't they want to know if I was satisfied and thought he was doing a good job?
What's wrong with this picture is that the delivery of the service has been disconnected from me the customer using it. It's like people who have to fly a lot for work but their tickets are bought by a procurement officer who doesn't care if the journey is crap so long as it's cheap.
The system is also screwed up in that I can't take my business elsewhere. I have to go to the doctors for my area. So my doctors practice, good or bad, is granted a monopoly on delivery of doctoring to the people who live near me.
What's wrong with this picture? I think it's that doctors have a virtual monopoly on their practice and are paid irrespective of the service they deliver to their clients. I won't accept that for gardening, getting my car fixed, or buying a computer. Why the hell should I accept it for something as serious as my health?
Beyond that it can't be good for the doctor: If my doctor is great I can't recommend him to my friends. My friends can't go to his practice. His practice and his wallet can't swell because of the great job he's doing. He can't bring in new people, train them in his methods and expand.
On the other hand if my doctor offers poor service I can bad-mouth him to my friends but, ultimately, I have no sanction. It's not like I can just drop in at the practice up the road and take my money to them. I wouldn't be welcome since I'm not on their list. Worse yet, if my doctor takes a dislike to me he can get me struck off his list. Then where the hell am I?
I think the solution lies in taking the money out of the hands of the central planners and putting it where it belong: in the hands of the patient. Good doctors will thrive and grow their practices, bad doctors can find another career.
You may argue that this means that there will be competition for the good doctors and their prices will go up. Well, in the short term yes. But right now the situation is that if you get a crap doctor you're stuck. Is that better? Or fairer? At least in the market if good doctors command a premium there is an incentive there for more to get trained and join in.
I'm still evolving my thinking around this area. But I'm convinced this system needs to change.
Update: Andy took one look at my description and suggested it might be post-nasal drip. Certainly it sounds close and I was without my antihystamines last week because I didn't get the prescription filled in time. I mentioned the antihystamines to my GP but he wasn't interested.
Andy also made the point that the GP is probably tired, he's likely overworked, under-appreciated and in the system he's in, similar to HMO, just figure out what specialist he can send you to.
That's an excuse that gets trotted out a lot for underperforming doctors. I can certainly forgive the doctor but I can't forgive the system that lets a doctor who is unable to treat the patient keep on racking up his numbers.
I mean do you really have to be "Chairman, Department of Surgery" to come up with post-nasal drip as a suggestion?
My current plan is to get back into my antihystamine regime and try to avoid dry environments and see if it clears itself up. Oh and chew a lot of gum!
Update#2: And if we want to consider the economics of the thing, how much will my consult with an ENT specialist cost the NHS? If we assume that his first reaction will be post-nasal drip (which could have been ruled out before I saw him) then I just wasted a consult and maybe held up someone with a more serious complaint.