Good, was all I decided to say in response. He neither thanked me nor criticised me for my decision to send him to hospital that day and so we never discussed it.
Over the previous year I had engaged Tarig in numerous theological debates and completely failed to persuade him that God didnt want him to die. Clearly it took his own near-death experience for him to come to this conclusion himself. Im just relieved that he did.
Should we know how much health care costs?
The NHS is running out of money. We are told this on an almost daily basis, but what you may not be aware of is that GPs like me have been told that we are now going to be the people in charge of balancing the books. One of the reasons that GPs have been given this large responsibility is that we generally run our own surgeries fairly efficiently and it would appear that, at the time of writing, the coalition feel that this effective management can be extended to the entire NHS. The truth is, I dont really know much about accountancy. My surgery runs efficiently enough, but only due to my heavy reliance on our practice manager. She steadfastly makes sure that there is enough money for everyone to get paid and that we get the best deal on our toilet roll order. I get on with trying to make the patients get better and as a business plan it works well enough.
I was against the new health legislation, but am not totally against both doctors and patients actually knowing how much things cost. Each day I sit with a metaphorical book of blank cheques of taxpayers money and I write up prescriptions, order tests and make hospital referrals. All of these have a price and therefore cost money to the NHS and hence all of us who pay tax. Up until recently I was blissfully ignorant as to how much these all cost, but GPs are now being put in charge of the local health budgets and as a result of these changes, I am now beginning to get an idea.
Many doctors and patients are scared of thinking of health care in terms of money. The fear is that we medics will no longer see you all as real people in need of medical support, but instead as pricey leeches draining away our budgets. I would like to think I am capable of considering the financial value of what I do without it automatically having a detrimental effect on my clinical decisions.
If it were up to me, I would make up for the NHS shortfall by scrapping the recommissioning of Trident nuclear submarines £20 billion would make our budgeting meetings considerably easier to bear. With that sort of injection of cash, the improvements we could make to patient care would be staggering. Of course, the whole point of the coalitions new health act is to make do with less money rather than more and therefore the only places well find any cash will be through reducing our own inefficiencies. Anyone who works within the NHS could list several ways in which we could work more efficiently. Traditionally, doctors have thought of these shortcomings in terms of wasted time for us, and poor service for patients, but now we will be encouraged to think of them from a more financial perspective.
My first job after qualifying was as a junior surgical doctor and I had a particularly frightening consultant. His ward rounds were terrifying and when he demanded a patients blood results, I was expected to know them. If I didnt have them to hand I was on the end of a bollocking that could be heard from the other side of the hospital. My response to this was to do blood tests on all my patients every day to make sure that I had every possible result to hand. Not only were my poor patients often unnecessarily stabbed with a needle each morning, but I must have personally cost the NHS a small fortune. How much? I have no idea. To this day I dont know the cost of a standard blood test, but I should, shouldnt I? Im not suggesting that doctors shouldnt order blood tests any more, but clearly knowing the financial value alongside the clinical value of what we do is important.
One of my patients got the shock of his life recently when he discovered the actual cost of the injections he is having for his rheumatoid arthritis. He has one per week and they cost £178.75 each. Thats twice his weekly rent. He wanted to know if he should add them to his house insurance, as when he has four syringes of the stuff sitting in his fridge, they are more valuable than anything else he owns. Of course I dont begrudge him these injections. I am extremely proud that the NHS provides them for him. They have allowed him to continue working and kept him off benefits. They make a massive difference to his quality of life, but Im glad he knows their financial value as it means that he treats them with the respect they deserve. He understands how precious each vial is and ensures that they dont get smashed or accidentally thrown out with the mouldy vegetables when his fridge gets a clean.
The government is planning to send us all a breakdown of exactly what our tax is spent on. Should we be sent something similar about how much we cost in terms of our health care? I dont want anyone to be made to feel guilty about using the NHS, but how many of my patients who miss a hospital appointment realise that each failed attendance costs around £120. Or that it costs £59.48 for the asthma inhaler that keeps getting left on the bus and £244 for the ambulance needed to get to A&E after drinking to oblivion on a Saturday night. I dont advocate anything other than a free health service at the point of delivery, but just knowing the financial value of what is provided is a good thing for patients and doctors alike, isnt it?
Danni I
One of the most striking things about Danni was how unattractive she was. I couldnt quite believe that men paid money to have sex with her. This cant help but sound incredibly mean, but it really was my gut reaction when she first told me her profession. Danni was 25 years old, but so slight and slim she had the body of a 13-year-old. Her face, however, looked older than her years and was dominated by bulging dark eyes with large bags underneath and sharp protruding cheekbones. Her lips were thin and the angles of her mouth were cracked with sore-looking red lines. The medical term is angular cheilitis and I remember learning at medical school about various causes. In Dannis case the cause was basically malnutrition. The only things that went in her mouth were Coca-Cola, cigarettes, a crack pipe and her clients penises.
I was curious to know how much she charged. I knew she spent almost every penny she earned on crack, but I wondered whether she got paid directly by her pimp in drugs, or got to walk away with a bit of cash in her pocket. I nearly asked her, but deep down I knew that I couldnt really justify this question as part of my medical consultation. She had a childlike respect for authority and if Id asked the question she would have answered without hesitation. Much as I was tempted it wasnt fair for me to feed my voyeuristic intrigue. I also didnt want her to get the wrong idea as to why I might be asking about prices for her services.
I could tell Danni was nervous because she was incessantly putting Chapstick on her lips. Taking off the lid, twisting the bottom and smearing her lips every few seconds. Im fairly sure she didnt even realise she was doing it and the Chapstick was probably a substitute for the cigarette with which she could normally occupy her hands.
Im sorry, Dr Daniels, but Im a bit mucky down below. I think I might have picked something up again. She looked genuinely apologetic, as if shed really let me down.
I thought you promised me you were always going to use protection from now on.
Yeah, I meant to, but its getting harder and harder to find decent punters. The Eastern European girls have driven the prices down and I can only get work now if I go bare back. Its the recession.
Normally it was just plumbers and carpenters who complained to me about EU labour migration and the double-dip recession. I hadnt realised it was affecting the oldest profession as well.
But its dangerous, Danni. You could catch HIV.
Danni looked up at me like I had just told her off; I had rarely felt so paternal towards a patient.
He was one of my regulars, so I thought it would be okay.
The idea that a client who regularly used prostitutes would be less likely to have an STI seemed an odd concept but I wasnt going to take her up on it.
Hes the dad of my two kids, she added nonchalantly.
The dad of your two kids is still one of your clients? Do you still charge him?
Well, he pays the other girls so I dont see why he shouldnt pay me.
After a few years in this job I thought nothing could surprise me, but Danni had left me absolutely speechless.
Hes not looking after your kids, is he?
No, theyre still with the foster family. The social worker says that if I stay clean for six months Ill be allowed supervised contact.
Thats great and hows that going? Staying clean I mean.
Dannis hesitation said it all and we both knew she was no closer to kicking her habit.
I ended the awkward silence by asking her to get up on the couch so I could examine her. The discharge looked and smelled like gonorrhoea, but I sent off some swabs to be sure. Some of the medical advances made over the last 150 years have been incredible, but go back to Victorian Britain and you would have found a doctor like me examining prostitutes for gonorrhoea in much the same way. Medics can now look at MRI scans on their iPhones and blast away tumours with lasers, but we cant seem to stop those same old-fashioned gonorrhoea bacteria being passed to and fro in precisely the same way they always have done. In Victorian times doctors prescribed prostitutes with compulsory doses of mercury and arsenic for gonorrhoea. At least Danni had come to see me voluntarily and I could give her antibiotics rather than poison. There have been reports of antibiotic-resistant strains of gonorrhoea, but thankfully our local variety generally still responds to penicillin.
I am sorry, Doctor, Danni repeated.
Dont be sorry, Danni. I just want you to look after yourself.
I will, I promise.
The NHS, the envy of the world?
The NHS is the envy of the world although apparently its not the envy of many Polish people living in the UK. Such is their dissatisfaction with our health-care system, many of my Polish patients go home to seek medical care and two Polish doctors have set up their own private clinic in London, which is apparently thriving. I could quote data showing how good our health care outcomes are in comparison to other nations, but for most people, personal experiences outweigh any statistical evidence that I can offer.