Baby’s got back (problems)

Apologies in advance – this is going to be a long post that doesn’t mention Macs, digital downloads or murdering cartoon characters. Apart from that sentence, heh.

Just over ten years ago, I had a disagreement with a bit of gym equipment and ended up with a slipped disc. Ever since then, I’ve knocked my back out with alarming regularity, and it doesn’t take much: a few years back I managed to slip a disc picking up a piece of paper, which was rather embarrassing. So when I knocked it out yet again fitting an oven, I wasn’t particularly surprised. Here we go again, I thought. Painkillers, physio and a good bit of self-pity for a few months.

Unfortunately, the problem didn’t go away after a few months – painkillers and physiotherapy helped a little bit, but whatever the underlying problem was this time, it didn’t respond to treatment. Falling down a set of concrete stairs soon afterwards didn’t exactly help, either.

The current back problems started in April, and after the usual physio and painkillers I was discharged in September on the grounds that the NHS had done as much as it could. They’d given me some exercises that helped a bit, but it was pretty obvious that the underlying problem hadn’t been addressed. I spoke about it with my GP a few times and he agreed that the only way forward was for me to get an MRI scan to find out exactly what was knackered; unfortunately, tight cost control by the local NHS funding body meant that an MRI was out of the question. Too expensive. As my GP explained, if I had lost all sensation in my feet and all control of my bowels, then he could get me an MRI within a few months; otherwise, a scan was out of the question.

I’m the first to admit that my back problems aren’t that serious: while I can’t lift weights or do DIY, I’m still mobile. But it’s still debilitating, because I can’t sit still for more than a few minutes before my back goes crazy. The biggest problem for me is sleep, or lack of it: I can’t sleep for long periods without waking up in pain. To put it simply: I’m bloody knackered.

By November I was starting to think I’d never get better. I did find one source of help, though: Squander Two recommended a chiropractor called Ian Dingwall and described him as a miracle worker, and he was right. Half an hour of being beaten senseless by Ian doesn’t fix the back problems, but it does make them much more bearable for a few days. Best of all, Ian has seen the film Jacob’s Ladder and understands my fear that if he cracked my bones too hard, I’d end up having Vietnam flashbacks (if you haven’t seen the film, that won’t make a great deal of sense. Heh).

In January, it became obvious that there was a pattern developing: Ian would throw me around the room every week, and after two or three sessions there’d be an improvement in my overall situation; on the fourth or fifth week, I’d be right back to square one. Both Ian and my GP agreed: something needed to be done.

Of course, an MRI was still out of the question: my doctor was sympathetic and frustrated, because he reckoned I needed a scan but couldn’t refer me for one. We discussed seeing a neurosurgeon, but the waiting lists were very long just to get an initial appointment – so I decided to go private.

I was already getting private medical treatment to some extent – Ian’s services weren’t through the NHS, so I was paying £30 a week for treatment – so I had some idea of the speed at which things happen. But I was still surprised when I called to make an appointment with a neurosurgeon and saw him within four days. Of course, such a service comes at a price: £130 for a 20-minute chat. During that chat we discussed various options, and agreed that an MRI was an essential next step.

MRIs aren’t cheap, but it seems that they’re cheaper in the private sector than they are in the NHS. Whenever I discussed MRIs with my GP, the figure of £1,000 was bandied about; Glasgow’s private hospitals – Ross Hall and Nuffield – do them for £450 and £350 respectively. As with the neurosurgical consultation, they happen quickly too: four days between phone call and scan, and another two days to get the scan results.

Incidentally, MRI scans are bloody terrifying. They manage to combine every bloke’s fear of hospitals with every person’s fear of being buried alive; according to the nurses at the hospital, the majority of people who’ve had an MRI scan vow never, ever to have one again.

The other thing about MRI scans is the “black dog” problem: if someone says “don’t think about a black dog”, you immediately think of a black dog. With an MRI, you’re told not to move a muscle – which means that your body immediately wants to start disco dancing. It isn’t helped by the noise the MRI scanner makes, which is a rhythmic, electronic pulse that sounds like a Kylie Minogue backing track.

Thanks to the MRI scan, I know exactly what the problem is – two prolapsed discs, pressing against nerves and generally making me grumpy – and what my options are. Some form of back surgery is almost inevitable, and while I’m scared to speculate on how much it will cost I know that by going private it’ll be over and done with quickly.

There is a point to this, honest.

So far the combination of chiropractic treatment, consultations and scans has cost a few thousand quid – while waiting on physiotherapy last summer, I spent hundreds on osteopaths and other alternative treatments – and by the time I get surgery (and follow-up treatment) the whole bill is likely to be several thousand pounds. Private medical insurance would have cost me a fraction of that amount but like many people, I assumed that if I had a problem the NHS would be able to accommodate me.

I was wrong, of course. The problem is one of money: there’s only so much money kicking around the NHS, and we’re placing more demands on it by the year as we live longer, as we find new ways to treat people, as medical advances enable us to do things we’ve previously been unable to do. While politicians fiddle with the NHS every few years, they’re not fixing the fundamental problem: the NHS can’t do everything.

No politician in their right mind would suggest this – it’s a guaranteed vote-loser – but one of the obvious ways to solve the NHS problem is to tell people like me, “you’re working, so you should have health insurance”. That would return the NHS to its original role as a safety net for people who can’t afford private treatment, and as a provider of accident and emergency care. For everything else, you’d need medical insurance.

Whenever such a thing is suggested, there are howls of protest. Do we want an American-style system? I used to think the same, but there was a fascinating article in last week’s Spectator that made me rethink my attitude. The US healthcare system is regularly used as an example of what we don’t want in the UK, but as the Spectator article pointed out, in many respects it’s superior to the NHS. In almost every conceivable area, waiting lists are much shorter, treatment is more effective and in the case of potentially fatal illnesses, survival rates are considerably higher than they are in the UK.

Suppose you come down with one of the big killer illnesses like cancer. Where do you want to be — London or New York? In Lincoln, Nebraska or Lincoln, Lincolnshire? Forget the money — we will come back to that — where do you have the best chance of staying alive?

The answer is clear. If you are a woman with breast cancer in Britain, you have (or at least a few years ago you had, since all medical statistics are a few years old) a 46 per cent chance of dying from it. In America, your chances of dying are far lower — only 25 per cent. Britain has one of the worst survival rates in the advanced world and America has the best.

If you are a man and you are diagnosed as having cancer of the prostate in Britain, you are more likely to die of it than not. You have a 57 per cent chance of departing this life. But in America you are likely to live. Your chances of dying from the disease are only 19 per cent. Once again, Britain is at the bottom of the class and America at the top.

How about colon cancer? In Britain, 40 per cent survive for five years after diagnosis. In America, 60 per cent do. With cancer of the oesophagus, survival rates are low all round the world. In Britain, a mere 7 per cent of patients live for five years after diagnosis. In America, the survival rate is still low, but much better at 12 per cent.

…Look at any proper measure of the capacity or success of a medical service and one finds, again and again, that America comes out better. In Britain 36 per cent of patients have to wait more than four months for non-emergency surgery. In the US a mere 5 per cent do. While in Britain the government celebrates if the waiting times get a bit lower, in America they don’t do waiting.

There are more American doctors per patient so, not surprisingly, patients have more time with their doctors. American patients also get to see specialists as a matter of routine whereas in Britain 40 per cent of cancer patients, for example, don’t see a cancer consultant. There are shortages of specialists in many areas of medicine in Britain.

The article points out that in the US there are more doctors per patient, more MRI scanners (and crucially, the scanners work around the clock; in the UK, they run during office hours), more surgical consultations, and so on. It also demolishes the myth that poor people are ignored, while accepting that the US system is far from perfect (US healthcare is ruinously expensive and leads to a huge numbers of bankruptcies, but there’s a safety net for the poor; the problems tend to affect people in lower-paid jobs or temporary unemployment).

The full article is now behind the Spectator’s pay-to-read barrier, but if you Google for “Die in Britain. Survive in the US” you’ll find the text on the web (I won’t link directly as it’s infringing the Spectator’s copyright). It’s fascinating stuff and while I’m sure some of it is flawed – articles that rely on statistics usually are – it’s still very interesting.

We’re weeks away from a general election, and as ever the various political parties will be claiming that health is their number one priority – but no matter what party you listen to, you won’t hear anyone suggesting a major revamp of UK healthcare; instead, you’ll be presented with various different versions of the same approach. The politicians are running around with sticking plasters when what the NHS needs is major surgery.

Update, 10 March

If anyone’s interested, my neurosurgeon has ruled out back surgery because the potential benefits don’t outweigh the risks. So it’s drugs, drugs, drugs from now on.





0 responses to “Baby’s got back (problems)”

  1. It was a brilliant article. I liked the way it pointed out that, yes, the American system bankrupts some people, but it does so while saving their lives. In the UK, we get to keep our money and die.

    The problem isn’t just one of money, though. Probably a greater problem is the way the NHS is run: as a centralised command economy. Unsurprisingly, since it’s run in exactly the same way, it suffers from the same problems as the USSR.

    People who support state-run health services are fond of saying that health is too important to make patients spend money on it. The opposite has become a bit of a mantra for Vic & me: your health’s too important not to spend money on it. Lord knows we can’t afford Vic’s private treatment, but, if we had relied on the NHS, she would no longer be able to walk upstairs and might not be able to walk at all, just because she strained a muscle a couple of years ago. The NHS’s prognosis was that you can expect a bit of wear & tear in your knees and walking difficulties as you get older — this to a woman in her late twenties. The private sector’s attitude has been to try and fix the problem.

    I can now drive or stand up for more than half an hour at a time without excruciating pain thanks to the private sector. The NHS tried to prescribe me Ibuprofen. Money well spent, if you ask me.

  2. Gary

    I think you’re right, it’s money and the very nature of the NHS.

    I’m not really sure what the argument against private health insurance is; surely if people like me can’t use the NHS but have to rely on insurers instead, that means a bigger wad of tax floating around for the people who don’t earn? It’s not as if any such scheme would let me off with my income tax or NI payments, after all. We’ve done it with pensions – our generation has effectively been told, forget a decent state pension – so there’s no reason (other than media-driven electoral suicide) not to do the same with health. And because all that money would suddenly have to provide for fewer patients, it would remove the possibility of a two-tier health system in terms of quality.

    The thing about the MRI scan in the article struck me as interesting: they’re hugely expensive machines, which is why the scans cost so much. By taking the US model and running them around the clock, the cost per scan would decline and the waiting lists would be cut by two thirds. It seems so obvious.

  3. I was watching Mark Steyn being interviewed on C-Span (link is on Little Green Footballs if you’re interested) and a caller asked him, as a Canadian, to compare the American and Canadian healthcare systems. (Canada has an NHS-style system as befits the only Euro-socialist economy in North America.) Mark said that every time he had a medical problem, he drove down to the States, because he would wait forever to see a Canadian doctor. He said the American hospitals are full of Canadian doctors- and Canadian patients!

    In South Africa, where I lived until five years ago, the national healthcare system is a safety-net system: everyone employed has health insurance, and uses private healthcare, which is of a very high standard. Coming to the UK has been a bit of a shock. I visited a friend in UCH a few weeks ago, and was lucky to catch her being moved to a new ward one day. The reason: the ward she was in was closed on weekends! Her relatives literally wandered the halls for hours before they found her in the new ward.

    The problem does lie with the lack of incentives for efficiency inherent in government-run enterprises. In private healthcare the doctors want to see as many patients as possible, because it means more money. (Those who financed the MRI want it paid back as quickly as possible so it runs 24/7.) In the NHS everyone is paid regardless of how many or how few patients they see: hence there is major resistance to accepting patients and moving patients around in the system. GPs are reluctant to refer patients on because of the flak they’ll get.

    A doctor friend of mine told me an amusing tale of the lengths he has to go to to get an A&E patient referred on. He knows if he phrases the diagnosis in one way it will give the referring department the excuse they need to reject the referral, but if he phrases it another way, the patient will get the wrong treatment. He has to constantly be aware of the political games played by each department to reduce their inward referrals.

    Not only is healthcare too important for individuals not to spend money on, it also empowers individuals to decide how important health is to them and what level of risk they are prepared to bear. Judging by the number of people who smoke, drink-drive and never exercise, health is a lot less important to most people than the government would have us believe. So let those who couldn’t care less make do with a bare-bones, A&E-oriented safety net health service, while the rest of us save our taxes and put them into the level of health insurance we feel comfortable with.

    Oh and Gary, I hope your back problems are resolved. Be careful of surgery: I know of many unsuccessful cases of back surgery, and I am wary of surgeons who are addicted to surgery (literally: I know one who almost gets a physical high from it!). Find people who don’t have hammers: not every problem is a nail.

  4. Gary

    Thanks for the warning, but I’m not too worried. The surgeon I’m seeing is very much of the “surgery is a last resort” persuasion, and he’s got a tremendous reputation (ie he’s no doubt insanely expensive too).

    Obviously I don’t want surgery if I can possibly avoid it, but I can’t spend another year like this. It’s not so much the pain as the lack of sleep – I consider 5 hours a luxury at the moment, which means I tend to be even grumpier and more prone to writer’s block than usual. I think if I’m like this for another 12 months my darling wife will murder me :-)

  5. Gary

    Sorry, meant to add a bit:
    > GPs are reluctant to refer patients on because of the flak they’ll get.

    I feel sorry for GPs, hospital docs, nurses and the like. They really get the shitty end of the stick.

  6. > media-driven electoral suicide

    I don’t think the electoral suicide is so much media-driven as politician-driven. Newspapers are far more willing to speak out against it than any MP. Mind you, the BBC don’t help matters.

  7. Gary, sounds like you’ve got it covered: obviously they aren’t all like my acquaintance. The friend I was visiting in UCH had had surgery from an by-all-accounts fantastic surgeon as well, a very warm and kind man who is spoken well of by everyone including the nurses: she found him by going to specialist after specialist, constantly questioning them and their assumptions, together with some research on her own etc. But I guess being a journalist you’re also like that, so I shouldn’t have worried!

  8. Squander, thanks for the Observer link: good to see some of their writers have the courage to question their assumptions.

    What gave me pause was looking at the article’s dateline: October 7, 2001!

  9. Gary

    That’s an excellent article.

  10. Tony

    >>”you’re working, so you should have health insurance”.

    So, how does this differ from taxation?

  11. Gary

    It might actually work?

  12. You don’t get sent to jail if you decide against it?