NHS make my blood boil!

[halfpint]

OK, I don't live in the UK any more, been in France for some years. Not going to go into the pros and cons etc. BUT one thing is soooooo much better over here. I really have no idea why on earth the UK don't adopt the same strategy. It would save the NHS time and money and space.

Patient is totally responsible for all records - x-rays, scans, blood tests etc. - They are yours and you look after them. And you take them with you on any visits to specialists.

If you go for a scan or x-ray, you wait afterwards for the specialist connected to the clinic to see them, you then wait for him to do a report and you are given the scans etc plus his letter BEFORE you leave the hospital/clinic.

Blood tests, nurse comes to the house, usually within a day or two of phoning. Blood test sent off. Results back within 2 days. One copy sent to the doctor, the other TO YOU. It also shows your last test results so you can instantly see if you are up or down, also the normal ranges so you can compare where you are.

Why on earth they don't do this in the UK I will never know. Too much of the nanny state, can't let the populace know what their health is like they wont understand and will get confused. OK some people may need protecting, but please stop insulting the intelligence of the majority. Make people responsible for their health and give them the means to do it. How on earth can people control things like diabetes if they are left in the dark - just keep taking the pills. This plainly doesn't work. Those that want to control their health must be given the information to do so.

End of rant.

 

[CathyN]

Good rant. Couldn't agree more!

 

[Robinredbreast]

OK, I don't live in the UK any more, been in France for some years. Not going to go into the pros and cons etc. BUT one thing is soooooo much better over here. I really have no idea why on earth the UK don't adopt the same strategy. It would save the NHS time and money and space.

Patient is totally responsible for all records - x-rays, scans, blood tests etc. - They are yours and you look after them. And you take them with you on any visits to specialists.

If you go for a scan or x-ray, you wait afterwards for the specialist connected to the clinic to see them, you then wait for him to do a report and you are given the scans etc plus his letter BEFORE you leave the hospital/clinic.

Blood tests, nurse comes to the house, usually within a day or two of phoning. Blood test sent off. Results back within 2 days. One copy sent to the doctor, the other TO YOU. It also shows your last test results so you can instantly see if you are up or down, also the normal ranges so you can compare where you are.

Why on earth they don't do this in the UK I will never know. Too much of the nanny state, can't let the populace know what their health is like they wont understand and will get confused. OK some people may need protecting, but please stop insulting the intelligence of the majority. Make people responsible for their health and give them the means to do it. How on earth can people control things like diabetes if they are left in the dark - just keep taking the pills. This plainly doesn't work. Those that want to control their health must be given the information to do so.

End of rant.

Well ranted, Very interesting to read, It does sound ideal :thumbup: Best wishes RRB

 

[phoenix]

I agree, I like having copies of tests etc. Nevertheless, the hospital I was diagnosed at and have attended since then does keep the records of all the tests/consultations there. (I seem to have a very thick file) I have no need to have a nurse come to do a blood test, I go to the lab myselfI.

I 'm not sure though that the reason is to let the patients know what's going . I think it's just a practical measure to reduce overheads for the doctors.
Until recently (ie internet) it would probably have been very difficult for most people to attempt to understand their test/scans etc Still more difficult in French. I think doctors are more paternalistic. They don't like/understand the British habit of self medication.There was a great discussion in my room when I was first diagnosed on why this patient should want to know whether they could use aspirin, paracetamol, ibuprofen etc... a couple of the docs couldn't understand why I wanted to know. One of my consultants was horrified at learning there was a carb counting course online.(dangerous, most patients weren't able to learn to adjust their own doses)

I think giving results directly to the patient serves 2 simple purposes.
1) to save money on administration because the doctors have to pay for that from the consultation fee . (they tend to dictate their notes or even just scribble something on a ECG/scan photocopy) They most often share a secretary who quickly types from the Dictaphone notes.
2)a specialist doctor does't necessarily have any long term commitment to the patient. He/she is paid by the task. (acte medicale) (patients can and do chop and change doctors)

It's hard to explain the differences to the NHS so sorry it's long (give up here :lol: ) It's basically a mixed state/public system. When you see a doctor outside of a state hospital (all outpatients appointments) you are a private patient and therefore the doctor has to pay for all his secretatial support etc. They naturally keep it to a minimum


My diabetologue who I first met as an inpatient is paid privately for my follow up 'outpatients' appointments.(even in the same building). There are no nurses or anyone else at this appointment. ... the secretariat in 'outpatients' is shared by the doctors and is tiny. Because the appointment is for diabetes, the state pays 100% for this and I don't pay upfront because it is at the hospital.
If it were for another condition or the appointment was outside the hospital, I would pay and be fully or partly reimbursed.

The same goes for GPS, physios and even community nurses. You can of cause choose which one to ssee.
As they are 'private' the doctors pay all their own overheads from relatively small payments. Naturally, these are cut down to the minimum Hence small numbers of secretaries and a reliance on patient kept records/patients taking reports from one doctor to another. In the case of things like lab tests, it is you who are buying the service , you can choose which lab, so the naturally the report is sent to you (though they also send a letter to the doc who prescribed it)

It works if you (the patient) are organised; if not?
You also have to make all the appointments for things like retinal scans yourself , sometimes many months in advance .Again fine if you are organised.

Having a semi-private system can result in some problems. It's not all rosy.
Because you are paying 'privately' you may have to pay 'upfront' .. and in some months I've paid several hundred euros. My payments are all for diabetes so I get them back (less a small amount), if my husband sees a doctor he will get 70% or less back. Some of this may be refunded by a top-up insurance that we pay for.

Doctors can also charge more than the state will pay back.
Where I am ,in the sticks, with lower overheads (incomes, accommodation) this doesn't happen so much, but in the big cities many of the doctors can (and possibly need to ) charge considerably higher rates.
Then who you can see is dependent on your ability to pay, or your ability and forethought to buy a more expensive top up insurance.
If you have a job with a good income this insurance will come as part of the salary, not so for someone on a low income . For the poorest the state provides a stop gap 'top-up. Nevertheless, some people here, even though the doctors charge 'normal' rates delay seeing the doctors because of worry over expense. (few of the elderly farmers round here have either teeth or dentures around here as the reimbursement for dental treatment is so low)

And what reduces admin at doctor level, doesn't reduce the costs to the state. so contributions for state health care are expensive and can continue after retirement. (minimum 8% of taxed income, late payments are penalised after 2 weeks , for people in employment and especially for the self employed the contributions are much higher... and top up insurance is an additional expense)
The admin at the payment/reimbursement stage ; payments /reimbursements coming from the state/insurance and the patient themselves is very complex (can sometimes be chaotic) and must be very expensive.

 

[Sid Bonkers]

An interesting concept halfpint but what happens after an accident? You are taken to hospital possibly unconscious and the hospital have no way of finding your medical history/notes?

The UK are working towards every HCP having access to your medical records so even if you are out of area any hospital will be able to access your records, at present one hospital has to contact another hospital/GP for records.

I can see how it would save money when attending a clinic, diabetes, cardio, respiratory, whatever in as much as the secretary responsible for preparing that clinic and assuring everyones notes are there and ready could be retired, I dont think my wife and 1000's of other secretaries would think that a good idea, and I wonder how many people would turn up with out their notes or with some missing, my personal hospital notes are in a file about 3 inches thick and until 5 years ago I had never had a days illness or a hospital visit, and my hospital notes are small compared to many.

No on balance I still think the best place for my medical records are with the very people who are likely to need them most after an accident or emergency.

Also in the UK you are currently entitled to copies of all your medical records, you just have to apply in writing to your doctors and pay a small fee which I assume covers their time and copying costs.

If everyone in the UK asked for their records at once it would present quite a problem for all doctors I would imagine :lol:

 

[halfpint]

I suppose that there is good and bad in every system. The hospitals over here do keep records, but everything from the clinics, labs etc comes back to you. I never had any good experiences with the UK system, they **** nearly killed my husband on several occasions, mind you our local hospital here tried to do the same thing, but the big hospital in Bordeaux was fantastic. But I still think that all the simple things like scans, x-rays, labs etc should be yours automatically. When we moved out here we asked for all my OH files, what we got was worse than useless with all the important stuff missing. He didn't have diabetes but had been suffering from TN, which was eventually operated on here in Bordeaux.

 

[phoenix]

An interesting concept halfpint but what happens after an accident? You are taken to hospital possibly unconscious and the hospital have no way of finding your medical history/notes

We have a carte vitale , a card with a chip. This is what they use to check eligibilty and process payments. There were going to implement a system where doctors could input important info and it would kept remotely.
Great controversy over patient confidentiality so in it's latest format it will have a patient pin number, known to the patient and ony disclosed to the doctor if they want. (not much use if unconscious)
The scheme has stop/started and isn't implemented yet. Don't know what the new government will do.
http://www.computerworlduk.com/news/pub ... ates-cuts/

 

[Patch]

I absolutely LOVE This idea.

 

[halfpint]

Good god, I hope they don't do anything like that with the carte vital. Had nothing but problems with ours, no, correction, mine. First applied for carte vital when arrived out here, worked for a couple of months, then they cancelled it, and was eventually put on OH's carte. Then they cancelled me on it and had to re-apply when started a business. Then they cancelled it when he retired. Talk about off and on and off and on - daft. So, not everything with the french system is hunky dory. There are lots of problems with various systems out here, no mistaking. But keeping your own basic info is not one of them. i.e. having teeth out in hospital, if your dentist has done x-rays, or sent you for a scan or anything like that, then you have to have the treatment in hospital. The hospital doesn't have to wait until all the info is finally sent to them, you have it in your hand and show the consultant when you go for your appointment. There is no repeating stuff that has already been done.

 

[noblehead]

Patient is totally responsible for all records - x-rays, scans, blood tests etc. - They are yours and you look after them. And you take them with you on any visits to specialists.

Not so sure I like the idea of keeping hold of medical records if it meant that non were held at the hospital or gp clinic.

If you go for a scan or x-ray, you wait afterwards for the specialist connected to the clinic to see them, you then wait for him to do a report and you are given the scans etc plus his letter BEFORE you leave the hospital/clinic.

This I do like, it would be great if this were to happen more often in the NHS.

Blood tests, nurse comes to the house, usually within a day or two of phoning. Blood test sent off. Results back within 2 days. One copy sent to the doctor, the other TO YOU. It also shows your last test results so you can instantly see if you are up or down, also the normal ranges so you can compare where you are.

Usually it's only 3 days at best before I can find out my blood results, if you tell the clinic or surgery in advance you can get copies of all letters sent to gp's or consultants sent to your home, not sure if all NHS trusts work this way but mine certainly do. I can't really knock our NHS and think the service it provides is fantastic, like anything else there's room for improvement but overall it doesn't make my blood boil.

 

[GraceK]

I've actually been a Medical Secretary on and off since 1973 and I can tell you I've seen some good and bad attitudes and changes in the NHS over that time.

I can also tell you that what began with a condescending manner towards patients by many doctors and clinicians, has spread to the admin section in most hospitals and patients are frequently looked upon as being difficult if they demand copies of their own records or clinic letters.

The very same people will then expect the patient to know what they've been diagnosed and treated with and why, when they turn up at A & E unexpectedly. OK we might have our medication list to hand but that's about all patients have, yet still we are asked numerous questions as to what we've been diagnosed with as a result of presenting our symptoms to previous GPs, Consultants etc - and most of the time we simply do not know because we're left out of the communication loop.

Because of that I DEMAND (and despite the fact I'm a Med Sec myself I can assure you that as a patient I'm treated with as much disdain as the next patient by some Med Secs who tell me 'their' doctor is 'very busy and can't accommodate my request for information) copies of ALL CLINIC LETTERS sent by Consultants to my GP, and I can tell you that had I not done that, then to this day I would still be one of the mysterious undiagnosed diabetics in the UK.

After many months of angioedema and anaphylactic shock an Immunologist finally agreed to see after initially refusing to see me despite THREE CONSULTANTS ADVISING THAT I NEEDED AN URGENT REFERRAL. He did a few brief simple allergy tests and decided I was allergic to dogs (not true) and discharged me from care after ONE appointment. I continued to suffer with angioedema and had 3 admissions to hospital via 999. I demanded a copy of his letter to my GP and discovered that the body of the letter said very little about my health but the tiny miniscule PS which he added suggested that my blood levels were abnormal and that my GP 'might like to check them from time to time'.

So the most important part of the letter was actually the PS and was OVERLOOKED by my GP and so it was left to ME to badger her for blood tests which eventually led to my diagnosis. Now then, had I NOT DEMANDED A COPY OF MY CLINIC LETTER I would be none the wiser and a lot sicker.

The NHS has a lot to be proud of but it also has a lot it should be ashamed of - and that is it's attitude towards the transparency of patient information and knowledge of our own condition. The NHS DOES insult our intelligence from behind its many uniforms and it's time that PATIENTS stood up for their right to information about their own medical status.

 

[SouthernGeneral6512]

Perhaps the difference is because of the revolution ... every citizen will have their own medical records

 

[halfpint]

SouthernGeneral you are probably right. Its the threat of the guillotine that does it. :lol:

 

[GraceK]

Considering the incidence of misdiagnoses, and diagnoses that have been made about you, and ? diagnoses that have been made about you and which are on your medical records, it's in every patient's best interests to have copies of EVERYTHING in their medical records so that they can correct their GP if necessary.

There have been incidences of misdiagnoses which have occurred simply because the doctor misinterpreted or misunderstood something the patient has said. Doctors, like everyone else are prone to hearing loss, deafness, making assumptions and language problems.

There have also been incidences where important information or notification of symptoms have been provided by the patient but has been ignored by the doctor as irrelevant.

It should be normal practice for patients to be given copies of the medical records being kept about them to ensure that they are accurate. To leave the recording of such an important thing as a meeting between a patient and an HCP as a one sided thing is madness.

We, as patients, leave so much of our personal welfare in the hands of strangers really, which is in effect what most of our GPs actually are. Gone are the days when we had a 'family doctor' who knew us and our family personally, knew where we worked, what jobs we did, what our granny died of, what uncle Joe suffered with. We don't have that continuity of care any more, and many young people don't even know what 'continuity of care' means because, like so many things of the past which have disappeared, our young people are not used to having them. So because we don't have that continuity of care, ACCURATE record keeping is absolutely VITAL.

And recently I experienced problems when I went in for surgery. I was booked into a particular hospital because it's theatres have all the bells and whistles required to cope with anaphylactic shock, which I'm prone to. I've had numerous trips to A & E to that same hospital for asthma attacks, pneumonia, anaphylactic shock and spent 5 days as an inpatient 2 years ago. I've had several appointments at Gynae Clinic there, been in surgery once before, and have seen a total of 7 doctors at that hospital for Anaphylaxis, Chronic Fatigue and Complex Needs. Two weeks before my surgery I advised my Consultant that I'd just been diagnosed with T2 Diabetes and she said she wanted me to come in for surgery the night before the surgery took place and she wrote ALL that down in my notes. I watched her do that.

What ACTUALLY happened later? I was sent a letter advising me of the date of surgery and telling me to come in at 9am, not the night before. When I queried that I was told 'there's nothing in the notes asking for that'. The day before I was due to go in I was telephoned and the slot was cancelled due to 'high level of emergencies'. I was told to go in the following day at 11am after fasting from 7am. OK, I did that. But when I got there I was told along with 6 other women, that there were no beds available so we'd be spending the day in the tiny waiting room provided, and when a bed became available we'd go in one at a time. At that rate I worked out that last one in would be going down to surgery at approx 11pm by which time I'd have keeled over!!!! Guess who they put last on the list? Me ... the diabetic/anaphylactic/asthmatic whose supposed to go down to surgery first.

I told the nurse I didn't think I could wait all those hours without food or drink and sitting on an uncomfy hard backed chair (believe me they were rock hard), I also told her about my medical conditions. She looked through my notes and told me there was NOTHING in there to indicate ANY of those conditions.

Now either all those doctors were pretending to write in my notes, or they wrote it in invisible ink, or the notes got lost, or the nurse was lying or couldn't be bothered reading the notes. I honestly don't know what that was all about, all I know is I'm sick of this almost secretive attitude within some parts of the NHS where patient records are concerned. Without automatic patient access, the NHS can basically DO WHAT IT LIKES where record keeping is concerned because there is no monitoring as to whether it's done properly or not.

And when it comes to surgery especially, it's essential that various medical conditions are KNOWN TO THE ANAESTHETIST. Your life is in their hands.

I think it's absolutely ridiculous in this day and age, that the NHS can still leave the patient out of the information loop. Would any of us feel comfortable sitting in a room with two or three or four other people who constantly whispered to each other ABOUT US, without including us in their conversation ABOUT US? No, we wouldn't. So why do we feel comfortable handing our lives over to the NHS without any means of checking they've got the information right and without any means of knowing what's being discussed ABOUT US, unless we go through a process of ASKING and PAYING for OUR OWN INFORMATION.

Sorry, but I think that's a very outdated and dangerous way of being. Of course there are patients who don't want to know what's being written about them, what's being planned about them, what's being said about them. And that's fine, they could opt out.

But there's been recent news about the LIVERPOOL CARE PATHWAY which is the pathway towards death that people are being put on WITHOUT CONSULTATION EITHER WITH THE PATIENT OR WITH RELATIVES.

Think that will never happen to you? Think again. Don't give up your rights to FREE INFORMATION ABOUT YOUR OWN HEALTH. Silence on certain matters is frequently taken as CONSENT.

 

[Sid Bonkers]

And when it comes to surgery especially, it's essential that various medical conditions are KNOWN TO THE ANAESTHETIST. Your life is in their hands.

Thats why the "ANAESTHETIST" will always come and see a patient prior to surgery and ask them a series of questions about their height and weight and medical history including any allergies in order to work out the type and amount of anaesthetic to administer and to decide if any extra ordinary precautions need to be put in place.

I think you may be a little paranoid here Grace, IMHO the doctors and nurses within the NHS only ever have my best interests at heart and if you really want your medical records you only need to ask your GP and they are available for a small administration charge, they are your records.

I feel your attack should be aimed at government and the politicians that decide how the NHS should be run and with what funding, rather than those who work within the NHS who usually do a very good job under considerable pressure with increasingly little thanks.

 

[CollieBoy]

Sid, I find your remarks that GraceK is paranoid, more than a little offensive .Her experiences may differ from yours and may be coloured by the fact that she has seen things from both the patients side and her time as a medical secretary.

 

[anna29]

Hi All.
To go back to the OP point - we in the UK 'can' request for our own medical records...

We have to apply for these to be released at a chargable fee [mine was £50] for ALL of them
to be released.
I had to apply via my local hospital [records dept]
I queried the charge for this and was told it will cover the photocopies ink used and the
registered postage used to mail them all to me safetly.
I 'did' recieve these 2-3 weeks later via the promised registered posting !

Since this - I simply ask at all clinics to have a copy of letters sent out to myself.
To prevent me from having to pay again !
I do get these from SOME clinics but 'not' all ...
Am intending on tackling the ones that dont though roblem:

Hope this can help others?
Anna.

 

[borofergie]

Patient is totally responsible for all records - x-rays, scans, blood tests etc. - They are yours and you look after them. And you take them with you on any visits to specialists.

If you go for a scan or x-ray, you wait afterwards for the specialist connected to the clinic to see them, you then wait for him to do a report and you are given the scans etc plus his letter BEFORE you leave the hospital/clinic.

This is one of the silliest ideas that I've ever heard.

Are you really advocating that we go back to a paper based records system in 2012? I'm all for access to records, but the idea that you should shuffle up to a hospital appointment carrying a wadge of coffee-stained paperwork that has been languishing in a filing cabinet somewhere in your sock drawer, sounds perfectly absurd.

I've no idea what my NHS number is, because it was on a bit of paper that is now lost somewhere in my filing system.

 

[Sid Bonkers]

Sid, I find your remarks that GraceK is paranoid, more than a little offensive .Her experiences may differ from yours and may be coloured by the fact that she has seen things from both the patients side and her time as a medical secretary.

My wife is also a medical secretary, so I think I have a pretty good insight into the NHS both from the point of view of a patient and as I talk to my wife every night about her day from an employees viewpoint too. Now it may be that my wifes experiences of working as a medical secretary differ from Graces but I assume her views are just as valid?

Perhaps I could have worded my remark a little better, perhaps that 'I thought her remarks were a little paranoid' rather than "I think you may be a little paranoid here Grace" and for that I apologise. I'm not as clever with words as some as I am dyslexic, thats not an excuse BTW just a statement of fact. But I still think |Graces post was extremely negative and shows NHS staff in a totaly unwarranted bad light, as I said earlier perhaps her rant should have been aimed at our government than our generally hard working NHS employees.

However I stand by my remarks that every patient is seen by an anaesthetist before an operation and that medical records can be made available on request.

 

[phoenix]

Are you really advocating that we go back to a paper based records system in 2012? I'm all for access to records, but the idea that you should shuffle up to a hospital appointment carrying a wadge of coffee-stained paperwork that has been languishing in a filing cabinet somewhere in your sock drawer, sounds perfectly absurd.

I've no idea what my NHS number is, because it was on a bit of paper that is now lost somewhere in my filing system.

Just back from the cardiologist. Letter to GP and diabetologist ready to take with me on my next visit. I've read the report and seen the data print out. Still paper dominated but all the results are also on the cardios computer so there is a backup.
(blood pressure deemed to be fine, ECG OK; surprised that the average overnight was only 104/59 will have to look that up; it seems low! ) Having your own results does make you start investigating things . )
Though I've a file of paperwork, the only things that I think I have that don't have copies at the hospital are non D related. I have my mammograms and a couple of dental xrays. Probably better than the colour coded system that used to be used to file x rays in hospitals (OK long time ago but I spent some time working in an xray dept; xrays were always going missing)

Big disadvantage of the semi private system (the real reason for non joined up 'paperwork) was the 78€ I had to pay, yes, I'll get most of it back but I think it must be very difficult for people on low incomes if they have several such appointments close together (and not all conditions are reimbursed at 100%). In fact someone who doesn't use oral medications for D would only get (I think) 65% back so would have to rely on private insurance for the rest.

The NHS
There are a lot of faults with the NHS but so are there with other systems.
What I pay for health care in France would now just about cover their expenditure. (including pump rental and disposables). It went up by a third this year.
We pay our contributions out of an income taxed in the UK (and my tiny pension and OHs slighlty bigger one are lumped together: no separate assessment) I have an almost complete NI record; other half has a complete one so we've 'paid' for health care in the UK and also pay in France (our fault!) so I feel I still have some financial interest in what goes on in the NHS (that's my justification for commentating)
I get cross with some of the negativity towards the NHS , I read on here. There are problems. I suspect there are problems in every system.
I see the NHS in practice with my parents , children and grandchildren. With my parents in particular, they bothnneed and have received a lot of care with many investigations and operations. My father in his mid eighties has in the last year, had a very expensive heart valve replacement,. He had fantastic care and speaks fondly of the staff who sat up with him all night, the night following his surgery. My mother has amongst other things Parkinson's and again, with a few exceptions ( in particular, a couple of individual members of staff on a general geriatric ward), she has also had very good care.