Synovial Syntax

The System

Posted on: June 21, 2009

This way, that way?

This way, that way?

The System is the tongue in cheek term I’ve chosen for the healthcare arrangments in England, under the National Health Service. Tongue in cheek because for all the individual instances of awfulness and excellence you find with clinicians, it’s the way the whole thing (doesn’t always) hang together that is fertile ground for writing. This post is just an introduction to it all so far. I’m sure there will be a lot to report in future. It excludes all other systems, such as the ones for Social Security.

As usual in the UK, I went to the GP with my initial symptoms of RA. He was unusually clued up, and our PCT (Primary Care Trust, which specifies procedures for testing and referral amongst other cost and quality management exercises) funds anti-CCP testing so I was tested for that. Got an off the scale positive and +ve RA factor, and a referral to our local secondary care trust, UCHL. I deteriorated rapdily during the nine week wait for the appointment. I did call and beg for cancellations for an earlier appointment but The System couldn’t handle that. I finally got to my consultation date, for which in preparation I weaned our second child onto formula bottles. I knew I’d be going straight onto some heavy duty meds. Note to others: don’t google your symptoms overmuch. If you have an off-the-scale anti-CCP and RA factor +ve combination, you will be told by two dozen websites that this is a strong indicator of poor prognosis. You only need to hear it once. More than once is masochism*.

After this initial consult, I’m seeing the main man every couple of months. When visits to him are less freuguent  they are to be interspersed with the rheumatoid nurse specialist. I can’t really comment on that role yet, as I’ve not seen her much, as I’m seeing too much of the consultant. What she has done is simply shadow him on discussion of drugs in, side effects out. One thing I do like is her availibility to answer questions on the phone. I’ve only used this once re: some bad side effects. Othertimes, NRAS does me fine.

Anyway, those nine weeks were hell, hard work, unmedicated essentially, major pain. And were only half the target time for rheumatologist waiting list. For all it’s faults, I’m deeply glad to be in The System so far. I am unimpressed by the way blood test instructions and results have been going astray between GP and UCLH, but otherwise the communication isn’t so bad. For it is all done on different computing systems.

I have no idea who I ask for: podiatry, referalls to gut and jaw specialists, physiotherapy. Sure I’ll find out sometime.

*This has just reminded me of the first ever grown up joke I ‘got’. A sadist and a masochist meet walking down the street. The masochist says ‘beat me, beat me’ and the sadist says ‘no’.


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