Saturday, July 24, 2004

MRI Scan

This whinge to be read in conjunction with others about My Doctor, AXA PPP Healthcare and the NHS.

The good news was that having been told the waiting list for the scan was four months I was slipped in quickly, after just three or four weeks - although I'm not sure that a surgeon recommending the fastrack is an encouraging thing.

So things were going really well, they rang me to see if the appointment was convenient (excellent) and said they'd send a confirmation letter (this was about 10 days before the appointment).

All well and good but the letter didn't arrive until the day of the scan ie I didn't get it until I went home after work on the day. That was OK though, I knew about the appointment anyway so that didn't matter too much.

The bit that left a slightly bad taste was that when i turned up at dead on 6pm (my appointment time) the lady asked if I'd had trouble finding the place. Hmmm? "I'm not late am I" I pointed out, knowing I wasn't. "You're supposed to be here 15 minutes early" she said. I showed her my letter and pointed out that it didn't say anything about that. It says so in the leaflet that came with the letter she said. When I said that I'd only got the letter an hour before the appointment so had not had time to read the leaflet she said anyway it didn't matter.

So why make a snide comment about it in the first place.

Now I know this is only a small thing, but they're often what makes the difference to an experience. You probably thinking shouldn't I have been early for such an important appointment anyway? Well normally I would, and if it hadn't been for exceptionally heavy traffic I would have been. However, when i'd been to see the surgeon a few weeks before, the letter had specifically said NOT to turn up early, you will not be seen before the appointment time and it'll only clog up the waiting room. If they wanted me early in this other department why on earth didn't they say so in the letter, and make sure the letter is sent early enough for me to receive it before the appointment. In fact what do they do between making the appointment and sending the letter, as I said before they rang up 10 days before, yet the confirmation letter wasn't sent until 2 days before. Why?

In fact wouldn't it make sense if they want you there at 5.45pm instead of 6pm to make that the appointment time. I can imagine them having weekly meetings and every time they're saying "aren't patients useless, most of them turn up late for their appointments, you think they'd make the effort wouldn't you for something so important".

AAARRRGGGHHH!!! Just put the right time on the letter and post the bloddy thing so people actually get it before their appointment.

Whilst on the subject, at 6pm the place was deserted and there were no reception staff. Now I can't be sure but i reckon I was probably the last appointment of the day. I don't know how much a MRI scanner costs but my guess is that it runs well into 6 maybe even 7 figures. Given that level of investment, the obvious demand as it takes four months to get an appointment, the capability of earning revenue via private patients and last but not least the ability to speed people towards recovery, why on earth wouldn't you run the damn thing 24 hours a day. The hospital is open anyway, the lights are on, the only additional costs you're going to incur is two staff members, the receptionist/form-filling/moaning at everyone 'cause they get there late/explaining about the scan type person and the radiologist. Given that the cost of a private scan at this hospital is nearly £700 and that you can do two scans an hour (mine took 20 minutes actually in the machine plus a couple of minutes to slide in and out) then you could afford to hire/train people to work shifts, pay them exceptionally well to compensate for the odd hours and barely make a dent in that kind of income.

The only question is whether people (patients) would be prepared to come in at that time and the chances are that if you need a scan then you'll front up at any time of the day or night rather than extend the suffering by another four months.

I really hope I'm wrong about this, surely the NHS can't be that blind to miss a win/win situation like this.

AXA PPP Healthcare

Just a small rant here.

Took out a private healthcare policy a year or so ago, there has been some conjecture as to whether I'm covered for a back problem that my doctor told me was not a pre-existing condition but was seemingly unable to fill in the form correctly to indicate that (see the My Doctor rant elsewhere).

This is not the fault of the healthcare company, they have been very helpful on the phone on the two occasions I have spoken to them.

My problem with them is twofold.

Firstly, the length of time it takes to get a claim form to you. Bearing in mind that when you need a claim form you are likely to be in some distress and/or pain you would think that a form would be despatched immediately. But no. On the two occasions I have required forms it has taken about two weeks from requesting the form to receiving it.

I was in severe pain, and although the form itself didn't priovide relief, it was a stage in the process which ultimately delays the final result.

As it happened twice I'm assuming that I haven't just been unlucky, but that this is standard. Whilst I've found the people to be very pleasant to deal with, am I overly cynical to consider that perhaps delaying forms may reduce the number of claims they receive as people may either get better, or die, or just not be bothered?

Secondly, my form was finally submitted (with a note trying to explain about my doctor's apparent difficulty with it) and I waited to see whether they would still cover me.

When I finally got a response it was just a standard letter which said they'd pay up providing I was covered. Well wasn't the whole point of sending the form to them to see if I was covered.

For goodness sake, your people are doing a really good job, they're very polite helpful, etc etc but you let yourselves down because the two things that stick in my mind are those I've mentioned above.

My Doctor

Although I generally try and avoid going to the doctor's whenever possible (typical British man I hear all you women cry) phases of ill health such as when I got hepatitis and glandular fever (the effect on my immune system also leading to other ilnesses at the same time including chickenpox and scarlet fever) have required treatment from time to time.

I have always had excellent service from my surgery, even when my doctor has changed the locums have been great. My wife and kids are all registered at the same surgery, although with a different doctor, and have nothing but praise. Their doctor is particularly good and makes things happen eg she'll pick up the phone and call the hospital whilst you're there to make sure you get a priority appointment when it's required, rather than just sticking you on a waiting list.

In fact, although we probably shouldn't, we have stayed registered at the same surgery despite having moved out of their catchment area, just because they have always been so good (we still own our previous house and have the mail forwarded so we have been able to {almost}legitimately do this, or at least get away with it). Incidentally, we are now in the process of changing over to a mroe local surgery.

However, with my recent back problems (see my NHS whinge) my doctor has caused me problems, and indeed pain.

I started a private healthcare policy a year or so ago, but there is a five year moratorium on pre-existing conditions meaning I cannot claim for any treatment for a condition I already had before I took out the policy. And rightly so, otherwise you could just buy into a policy when you needed some treatment. My problem is that I had a back problem four and a half years ago but I was re-assured when my doctor told me that the latest incident was entirely unconnected with the previous one. This conformed my own thoughts as the apin was in a different part of my back.

BUT...when it came to completing my healthcare form he entered the previous episode as a pre-existing condition thus ruling out any possibility of treatment. I returned the form to the surgery, along with my request for a repeat prescription (for the morphine he had put, and left, me on for over two months - without considering alternative forms of pain relief eg referring me to a pain clinic etc) and note pointing out that he had told me that he considered the previous episode to be unrelated.

When I collected the prescription there was no form with it. The admin lady at the surgery rang me the following day asking if I was sure I had handed it in as they had been unable to find it. Whilst she was very nice, and apologetic, she said that the only thing I could do was to get another form.

As you will see from my AXA PPP Healthcare whinge, getting a form is not the speediest process. When the form finally arrived I took it straight to the surgery with a set of notes as an aide memoir for the doctor, obviously including the word "NO" where it asked if this was a pre-existing condition.

A few days later the admin lady called me up again to tell me my form was now ready for collection and because of the inconvenience with having lost the form previously there would be no charge. I was thankful for this as until this point nobody had mentioned anything about this "service" being chargeable. I'd have thought that unburdoning the NHS by paying for my own healthcare was to be encouraged. that's a whinge that I needn't start on because I was getting a freebie.

And a good job too as he'd once again filled in the pre-existing condition bit, in the process stuffing my chances of cover. Just to add insult to injury, my original (lost)form was also in the envelope. AAARRRGGGHHH!!!

So my doctor either lied to me in the consultation, or was lying on the healthcare form, or didn't understand how to fill it in. What can I do about it? Well I suppose I could take it to the medical council but what I really want is just to be able to get treatment to relieve the pain I've been suffering for months.

Ultimately, this whinge is probably the only thing I can do about it, and you know what? I'm feeling better already.

NHS

The National Health Service, now there's a topic for a moan.

I've always had exemplary service from the NHS (for those of you outside the UK, the NHS is the system that provides free healthcare in the UK) and have always defended it against the "knockers". However, my recent experiences have been somewhat different.

First let me say that like many men I do not seek healthcare until there is no other option. I realise that this is not a sensible way to deal with ones health but it does reduce the burden on the health service.

I have had a back problem since last November, which turned into sciatica in February. By the end of March this was so consistently painful that I was unable to sleep for a couple of weeks, leading me to make a doctors appointment in early April.

The doctor prescribed some (supposedly) heavy duty painkillers. After two weeks these had made no impact on the pain and I was still unable to sleep. I was so worn down that by the time I went back to the doctor he sent me directly from his surgery to the hospital's emergency department, where after approximately six hours of writhing in pain, crying, on the floor of the A&E department I got to see a consultant who prescribed some even stronger painkillers and said that if the problem didn't sort itself out within about six weeks then it may be necessary to operate.

After another couple of days it was clear that the latest drugs were not working and, at my wits end, I got an emergency appointment at my doctor's surgery (although seeing another doctor) who said there was only one place to go now and that was the opiates. i was delighted to hear this as I felt I was finally going to get a painkiller of a strength that may help. Although he wanted to check me into the hospital for a day or two to start this process (not sure why, perhaps because it's easy to abuse or accidently misuse these very powerful drugs) we compromised and he allowed me to self medicate at home.

Finally, I at least had a drug (morphine) that allowed me enough relief from the pain to be able to sleep.

After this it felt as though the NHS forgot about me for a while.

I was simply left on the morphine awaiting an appointment with the surgeon/consultant. This finally came through sfter a couple of months, by which time I was well and truly hooked on the morphine. Not only was I having to take more and more of the drug to have the same effect but if I experimented with reducing the dose or missing a dose completely not only did the pain return but I also went "cold turkey", the symptoms of which were not unlike having flu. So now I had a drug habit to go along with my back problem.

Anyway, this is the bit where my gripes really start.

When I finally got to see the surgeon, he was able to identify exactly where and what the problem was in about two minutes (prolapsed L5 trapping the sciatic nerve for the record) but said I'd need an MRI scan.

Now apparently, this is par for the course. As I understand it, everyone who is referred to the surgeon has to have a scan, but only the surgeon can refer you for it. Given that it took the best part of three months to get to see the surgeon and then potentially another four months to get a scan, wouldn't it make sense that when the doctor referred you to the surgeon you went on the waiting list for a scan straight away. In fact there would be no need to see the surgeon until you'd had the scan.

Now apparently MRI scans effectively have a 'use by' date. They are literally a snapshot of what's going on in your body on a particular day and from the surgeon's point of view the older a scan is potentially the less accurate it will be and therefore the less use it is. So imagine my surprise when I ring the surgeon's secretary to make a post scan appointment and am told I'll put you on the waiting list, we are not currently allowed to see any post scan patients because of the government's target requirements for pre-scan waiting lists. I didn't even have to get angry on my own behalf, the surgeon's secretary did it for me, pointing out how ridiculous it was.

So, because the pre-scan waiting list is not allowed to exceed 17 weeks (remember that my opinion - formed by my own experience of the system - is that this appointment is unecessary as everyone has to then go for a scan) the really important post scan appointment is currently impossible to get.

She did qualify this by saying that the scans were at least looked at and if a situation was deemed an emergency then action would be taken. Other than this what on earth is the point of having the scan at all. It's incredibly expensive, it takes up valuable resources, it's of no benefit to the surgeon because you can't even get to see him once you had it done, and if you do ever get an appointment then the scan is likely to be so far out of date as to not be useful anymore. so then what happens, presumably the surgeon says you need another, up to date, scan and the whole circuitous process begins all over again.

How ridiculous!

This whinge has three other related whinges which I shall list separately. these are about my doctor, my private healthcare company and the MRI scanning process.


Friday, July 02, 2004

Perspective

I was reading "The Seven Day Weekend" by Ricardo Semler earlier this week and he talked about stress. And it brought it home to me in a moment that my kids feel just as much stress as I do.

The great weights of responsibility that hang over us as adults, parents, pet-owners, business owners, whatever, seem to be heavier than ever they have been before in our lives. But is it simply that the problem staring us in the face right now always seems to be larger and more insurmountable than anything before.

In fact, given that we have over the years developed the capabilities to deal with challenges, my kids falling out with their friends, forgetting to take an assignment to school, or any one of the thousand things they have to do in a week, are every bit as stressful for them as a cashflow crisis is to me.

And the sleepless nights I'm going to spend wondering how I'm going to meet this month's payroll is no more important than the things my kids are potentially worrying about, or more to the point, neither of them is that big a deal and as soon as the crisis has passed I'll forget about my current problem as quickly and easily as they will.

It's a cliche I know (aren't most things on this blog) but I recall a friend saying to me years ago when I was faced with a seemingly impossible business problem "In ten years time you won't even be able to remember what the problem was". It goes without saying that I remembered his words but not the problem

Like my kids perhaps all I need is a hug and a cuddle and someone to say "Don't worry about it, it'll pass, everything's going to be alright". The sad thing for us adults is probably that my kids stand far more chance of that happening - even sadder, the reason for that is probably that they'll make or let it happen.

Thursday, July 01, 2004

A Local Shop for Local People

Phew, it must be me!

Well I was right about these posts being likely to be gripes (or is it just that it's only the bad things that make you want to record your experience - like being sad is more likely to make you write a song or a poem than being happy).

Went into a trade electrical wholesaler this afternoon, admitted my ignorance as to specifically what it was I needed and would be grateful for any help - as it happens I was after some low voltage cabling for lighting.

I understood when the first assistant I spoke to said he couldn't advise a specification of cable BY LAW!! Fair enough, whether it's law or not I can understand that they wouldn't want to recommend a cable without specifically knowing the requirements as they may then be liable for any faults or damage caused by an inappropriate specification.

However, it went beyond that and I couldn't believe it when I asked what cables where available - so I could choose one - and he said he couldn't tell me what was available. Again, he was not qualified and it was illegal.

HUH?

Illegal to offer a choice of cables to a trade purchaser!!! (whilst I am ignorant of these things, as a company we are a genuine trade account - we install AV, home automation, electronics etc). And he says he's not allowed to even tell me what cables they can supply - Stuff and Nonsense!!! How do they manage to ever sell anything then? perhaps they don't with this kind of service.

A second guy came out and was a little more helpful, obviously having overheard his incompetent colleague, and did look for a particular type of cable in a catalogue for me - either the first guy was lying, very poorly informed/trained, having a bad day OR the second guy was prepared to flout the law and tell me what cables were available (without in any way recommending one for my use). I know which I believe.

In the end they didn't have an appropriate cable in stock, although the more helpful assistant did say they could get it in for me the following day.

Their slogan (from the front of the catalogue on the trade desk) was something like "Our stock answer is YES!". Mmmmm, a slogan that works on two levels, I get it. Just a shame that the service they are trying to describe doesn't seem to work on any level.

I have advised our engineers that they are no longer to use this outlet.

What I don't know is whether any of the alternatives are any better, surely they can't be worse and I'm certainly not going to let our company patronise them by default.

Sadly, this latest experience backs up my fears that poor service is the norm ratehr than the exception (or that I'm such a difficult customer I make problems for myself - whilst I'm obviously biased I can't accept that this si the case - I'm a very easy going and easy to please customer and certainly not a complainer, I'm quick to praise whenm things are good and try and overlook shortcomings as much as possible).

I genuinely hope that I am proved wrong.

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