Wednesday, 26 September 2007

Private Practice

I have never worked in private practice and have no intention to do so. When my wife needed to see an orthopaedic surgeon a few years ago we waited 18 months to see one on the NHS. I like the NHS and think when it gets it right it can be fantastic. It's nice when it all just works.

I've nothing against private healthcare, I just am sufficiently naieve and idealistic to see the NHS as the laudable preferred option.

What piques me is the pervasive whispering that episodically surfaces, insinuating itself into speech and media stories, that "going private" is, of course, going for a better service.

It isn't.

It's going for a different service.

I worked with an SHO (ST2 junior doctor in new speak) who moonlighted and covered a huge private hospital for a huge city on nights and weekends. Maybe he still does. He was the resident medical officer. He was the medic on the site. When ever there was a need for medical care, he did it (as he was the only one there).

When I was "on call" working on NHS medical wards I'd spend hours on Coronary Care and on the Haematology ward and covering scarily ill patients, but my medical Registrar and her Senior Registrar would do scary things (like cardiac pacing). It would happen almost instantly, we'd get bleeped, we'd dash to Coronary Care, we'd get pacing wires and run them in to the person's heart, fiddle with dials to capture pacing, exciting but scary stuff. I'm so glad there were House Officers, Registrars and Senior Registrars as well as my good self. Once we were busy through the night and at 8.00am the Cardiology Consulant arrived to meet us in Coronary Care. When his patient had (another) cardiac arrest the Consultant let us crack on and manage the event . . . the "junior" medical staff were much more familiar with such emergencies than the senior Consultant staff, thankfully the Consultant wasn't too proud to show that. An NHS hospital. Lots of staff, all doing lots of emergency work (we worked like Egyptian slaves) so got pretty proficient at what we did. If I had a heart attack and arrested, I'd want that sort of team managing me.

Cut to a private hospital. There's a SHO/ST2 junior doctor there. He's an SHO in psychiatry. He's never even seen cardiac pacing. He vaguely remembers how to resuscitate someone since he's got to attend an update every year or so, but it's not somthing he's seen or done for years. As a psychiatrist his knowledge of surgical and medical problems is modest. He was the only doctor in that hospital.

Now, in the private hospital, the surgery was done by a Consultant not by a trainee junior doctor. The food was excellent. The rooms were sumptuous. Flat screen TVs on the walls. Great selections of books and magazines.

Routine and elective care was excellent.

But in an emergency, would I rather be in an NHS hospital with a horde of experienced junior/senior trainees who could capably sort the problem out, or would I rather be in a private hospital with a psychiatrist who could ask me how I feel about it?

5 comments:

Cal said...

That's actually just quite scary.

I've always been a bit idealistic myself and believed in the NHS. I agree with what it stands for and the principles behind it.

I'm not going to pretend to understand the mangled politics that goes on behind it, but the actual NHS itself is a laudable idea, and one that I'm very thankful to have.

Incidentally, I've only visited a hospital twice over the last year (for purposes outside of medschool, obviously, and both were to accompany someone else and not for myself) and we've had nothing but a good experience.

The Shrink said...

That's actually just quite scary.
Ain't that the stark truth.

. . . we've had nothing but a good experience.
Me too :-)

Jan said...

I heard of someone who changed private hospitals because the wine list wasn't up to scratch. My priorities for what's available if I'm an inpatient are somewhat different to this.

jayann said...

Interesting how views have changed... when I was a graduate student, one of my class who needed a minor op chose to go to the London Clinic. All the other studentsurged her to go to a teaching hospital, on the grounds she'd get better care there.
Fast forward... I was describing my very good treatment at a Leeds (NHS) hospital to some patients at a Welsh one. They said sulkily 'It's OK if you can go private...'. The simple descriptkion of my good treatment had made them think it couldn't be NHS.
But though I have had good treatment I have seen very bad treatment. We can't gloss over the NHS's failings simply because we want -- and need -- to defend it.

Dr Grumble said...

..... my medical Registrar and her Senior Registrar would do scary things (like cardiac pacing). It would happen almost instantly, we'd get bleeped, we'd dash to Coronary Care, we'd get pacing wires and run them in to the person's heart, fiddle with dials to capture pacing, exciting but scary stuff. I'm so glad there were House Officers, Registrars and Senior Registrars as well as my good self.
***************
Most of what you say is absolutely right but the personnel you mention above barely exist now and the ones we have left rarely have the expertise to be able to put in a pacing wire. But an NHS hospital is still the best place to be if you are really sick.