NHS musings

I've been going to the NHS for several months now to seek assistance with my skin. My face, chest, and back have until recently been constantly coated with antibiotic-resistant, regularly refreshing acne, and it's taken its toll on my self-esteem. For about 5 years I have felt ugly, ashamed, and sad, which has inhibited my motivation to take care of myself, exercise, wear pretty clothes, or give a damn about anything aside from my fury-inciting reflection.

I started seeing a GP in September, who, after hearing my carefully documented treatment history over the past 5 years in the USA, began me on the exact same treatment I started on 5 years ago in the USA. I came to understand that if you move country, your health records aren't recognized as legitimate. Fun.

So I spent an entire academic year on a trip down memory lane--the same old treatments, the same old failures. Benzoyl Peroxide/clindamycin cream, BP/CY plus lymecycline tablets (topical plus internal antibiotics), Retin-A plus lymecycline tablets, more Retin-A, and finally "I can no longer treat you. I'll refer you to a dermatologist."

Great. 3 months of Retin-A later, my dermatology appointment arrived. I waited over an hour and got a ten-minute appointment in which I was told, "the next step is isotretinoin, but I can't prescribe that here. We'll have to re-evaluate you at the hospital and decide if it is best for you there."

Between starting treatment and reaching this point, I moved. Not a huge distance, but I moved from Greenwich's NHS trust to Lewisham's NHS trust, and continuing to see the same GP was becoming a hassle. After the move I asked if I could transfer my records and progress to Lewisham and was told no. "You'd have to start over from scratch."

I moved 4 miles, in the same country, within what I thought was the same health service (that whole "National" thing kinda threw me) but my records would not follow me. That makes no sense.

Nevertheless, I persevered, and six weeks later I was seen by no less than 5 doctors who all agreed, after I passed a pregnancy test (I suppose? Passing is being not pregnant, failing is being pregnant? Is pregnancy a failure? I mean with some medications it is, but what about at fertility clinics?) liver function test, cholesterol test, blood count test, platelet test, and additional pregnancy test, that I was a good candidate for Accutane. I signed the NO BABY forms, promised I would not remove my IUD, received my first month's supply of medicine, and got a little cold.

What's that about the little cold, you ask? How is that relevant?

See, in order to receive this treatment, for which I am very grateful, I have to go to one of the giant hospitals in Greenwich council. To get my blood tests, I have to wait about 2 hours in a vast, crammed-full lobby with hundreds of other outpatients, all stiff-upper-lipping through their godawful diseases. When my eyes get tired of reading I tend to quietly play "find the sickness" with my fellow patients. With many, it's dreadful diseases of the elderly--painful-looking skin and joint conditions that are both causes and symptoms of a sedentary lifestyle. Others snarf back slime while trying to entertain screaming and oozing children. Still other afflictions aren't apparent until you see the back-pain dance when their numbers are called. (And then there's the otherwise-fine folks like me, feeling apologetically out of place but staunch in our assertions that we deserve treatment too, and dammit, we pay our taxes and we've waited long enough.)

But as with all overcrowded hospitals, feeling fine on arrival is no indicator that you'll leave in good or better health. These people, coughing and even just breathing in your vicinity, are certain to share something during your afternoon in this poorly-ventilated, windowless sick-tank. At least half of them have been there an hour or longer, silently spreading their sickness to surfaces and staff alike. (hopefully not staff, but I couldn't leave the alliteration chain hanging.) The sniffles and subsequent nausea from knowing where that bacterium just floated over from leave me wanting a scour-shower when I get home--something I shouldn't do now that my skin has been made delicate and sensitive by my medication.

The thing is, none of this is necessary. I recognize that medicines such as Accutane are controlled substances, and reasonably so, and as such it may not be a good idea to dispense them at Boots. But there's no reason why they can't be dispensed at offsite dermatology clinics. With the right distribution controls it makes far more sense to provide medications at purposed pharmacies--if you run a general practice, the NHS pharmacy nearby offers a well-rounded supply of frequently requested drugs. If you run a neurology practice, next door you sell brain-related pharmaceuticals. You offer phlebotomy services at GPs, even if you occasionally have to send samples to larger labs for more obscure tests, and you do not make thousands of patients spend entire days waiting in stuffy, pathogen-rich disease transfer centres for testing and medication. That's a huge health risk--indeed, probably the biggest health risk in the entire system. F'ing Ellis Island was cleaner than this.

But no, those tight-fisted money grubbers at stage 2 of funding are fighting tooth and nail to keep that from happening. See, the big cheques come from the government to the hospital trusts, and they like to keep all their money to themselves. They distribute a little bit of it to community GPs and clinics, but the bulk of the cash never leaves the hospital. They account for this by offering all the services that would otherwise be distributed throughout the neighbourhood on-site, but crippled to near uselessness by three-month waits, overcrowding, under-staffing, and poor site management. Worse, referrals into the hospital are complicated by hundreds of different forms used by the hundreds of different GPs who haven't had the money to upgrade to something compatible with the centralized data system, or the last 10 upgrades to the hospital data system. So you walk up with your handwritten phlebotomy form and the receptionist spends ten minutes digging through her notebook of phone numbers to find a contact for the doctor's office who produced it so she can ask them what this form number refers to in the new system. Gaah.

Centralization has never worked. Big hospitals are the biggest culprits when it comes to accidental disease transmission and stress-related malpractice. You just can't cram all those different conditions into one place and expect things to be okay. Even with a huge full-time well-trained custodial staff shit goes wrong, sometimes literally.

Take Outpatients Out of the Hospital. Separate maternity centres from skin disease wards. Let people avoid six month queues by allowing more doctors to practice in more places, and let qualified pharmacists make informed decisions no matter where they are.

If you're curious (and have a strong stomach--otherwise please skip this paragraph), my skin is looking a million times better than it did this time last month. Thanks to it being that lovely time of the month my face is bumpy and my pores are enlarged, but I'm not seeing any of the typical redness, gross inflammation, pain, oil sheen, or pustules. The doctor says the bumpiness and pore enlargement should go away over the course of treatment. I've been getting some red patches on my arms but I moisturise constantly. My cholesterol and liver function are still fine. My hair stays clean for days on end, so I'm saving water, and interestingly--mom, get this--you know all that weirdness in my ears? That's been wet and inexplicable for more than a decade? I still hear the crackling noise whenever I swallow, but I've not had any active dripping all month. Indeed, my earwax is actual wax, not a fluid. Wow. (grossness ends)

Anyway. While I appreciate the NHS, there's a lot that can be done to improve it without increasing costs or reducing safety. If the conservatives can pull off what they claim they'll do in that regard, I'll applaud them. If, however, they let their grand scheme get buried in business-as-usual, I will not be surprised.