The NHS: Don’t Call Us, We’ll Call You

When you start wondering whether it’s better to be treated in Egypt rather than in the UK, it might be time for the British healthcare system to undergo a revolution.

At the end of last month, a Guardian link appeared in my Facebook feed that immediately touched a nerve. In an article titled “The doctor won’t see you now”, Victoria Coren Mitchell wrote about her difficulties in gaining access to her GP.

As a newcomer to the UK, I have had my own, admittedly different, issues with getting the kind of medical attention I believe I need when I need it. I made a comment to that effect on the Guardian’s Facebook post of Mitchell’s article and was taken aback by some of the responses I received from readers. “You still got time change your mind and go back to where you came from,” was one type of comment. A couple of others told me that GPs knew better than me whether I need a referral to a consultant. My comment was about my complete and utter inability to get a referral from my GPs to see a consultant about a condition I had they were unable to treat.

Although very frustrating for me, the condition I was talking about was a chronic skin condition I have had for years. I had seen several doctors over the years in Egypt, where I’m from, who were also unable to properly diagnose and treat me. My misplaced optimism that I might finally resolve the issue by visiting a British doctor is not the biggest of deals. I’ve had the condition for years. I can continue to live with it if I must. Or the next time I’m in Egypt I can easily schedule an appointment with another top-notch dermatologist and hope I might get somewhere.

I convinced myself that because my condition was not urgent or life threatening, it was all right if it was not treated. I had made three different visits about my condition to three different GPs in my local surgery to no avail. All three refused to refer me to a consultant until I tried their suggested treatment, none of which worked, and I completely gave up going a fourth time. Because of this experience and another, I no longer visit the GP with anything that I think can be delayed or ignored; a dangerous thing for anyone to decide. Despite all this, I still believed that getting access to the right doctors in the UK would not be an issue with more serious conditions.

That is until my British-born-and-bred husband, a Caucasian Scot (according to the comments made to me by some Brits on Facebook, this distinction seems to be important), fell off a horse and broke his collarbone while we were on holiday in Egypt.

At a public hospital in Egypt, Colin was seen by two different doctors and his X-rays were seen by an orthopedic consultant and by the deputy head of the hospital, who happens to be my neighbor. The latter two strongly recommended an operation to set the collarbone in place by a plate. The bone was broken in two, with one half significantly overlapping the other. We were meant to fly back home to the UK the following day. Although I am a native Arabic speaker, Colin is not, and I could sense his anxiety about being treated abroad in a context where he understands nothing. I asked the doctors if it would be all right to wait a couple of days until we were back in the UK before doing the operation. “As long as it’s within the first week after the injury it’s perfectly fine,” the orthopedic consultant told me. I signed a document saying that I was removing the patient from the hospital despite the doctors’ recommendations. Their recommendation was to sign my husband into the hospital that day and do the operation as soon as possible, most likely before the end of the following day. I preferred to get him home where he could have the operation done in a context he better understands and is more comfortable in.

Exactly 48 hours after his fall, Colin and I were sitting in a British A&E. He was seen by a nurse. Initially, she didn’t want to take a new set of X-rays. We had the ones from Egypt, even if they weren’t of the best quality. But after speaking with someone, she told us that there was no way for them to be sure those X-rays were indeed of Colin’s collarbone, so they would do a new set for us. The new X-rays, much clearer than our Egyptian set, showed a completely broken, significantly overlapping collarbone with two sharp bone fragments lying around the break. The nurse told us we needed to see a doctor, but because the bone was not protruding through the skin she could not send us to one immediately. The X-rays would need to go into a virtual system where orthopedic doctors would see the X-rays at some unknown point in time and then get in touch with us for an appointment, again at some unknown point in time. If they didn’t get in touch with us within a week, we were provided with a telephone number to call.

We were contacted by a receptionist the following afternoon. A doctor would see us the following Tuesday, a full 11 days after the injury and nine days after our visit to the A & E. “Do the doctors not think this is an urgent case?” we asked the receptionist. “I really can’t tell you. My job is to simply book appointments,” she said. “Is there anyone we can speak to just so we can understand the situation?” we asked. “I can switch the call over to a nurse,” she suggested. “THANK you,” I said. “I’d really appreciate it.” The call was referred to another number. No one answered.

We tried to get in touch with our GP. All the GPs in our local surgery were busy when we called. The receptionist found the results of Colin’s X-rays in their system. She promised to show them to one of the GPs and get back to us. “All we need is to understand whether it’s all right for us to wait without having anything done or if his situation is urgent and that he must be seen by a doctor,” I told the receptionist. “And if we need to see a doctor, we need to understand what we can do to see one,” I added. We never heard back from them.

My husband has private medical insurance. He spent several hours on the phone with the insurance company on the same day we went to A&E. He managed to book an appointment with a private orthopedic surgeon two days later. As a result of that visit, we decided to go forward with an operation. We were told it should be done as soon as possible so that the injury was still fresh and more easily worked on. We received a call from the private hospital the following day telling us that the earliest possible date a theater would be available for Colin’s operation would be one full week later.

In the meantime, Colin’s arm is supported in a sling bought in Egypt. He is taking pain killers prescribed by doctors in Egypt. He is experiencing considerable pain nevertheless, the breadth of his left shoulder has been significantly reduced, the skin over his left chest is bruised, and his collarbone will have begun a process of healing while in the wrong position.

On January 25, 2011, I was among hundreds of thousands, and then millions over the following 18 days, who revolted in Cairo’s Tahrir Square. The people’s demands on that first day were focused mainly on dismantling a corrupt police force in addition to getting better healthcare and education. The demands then escalated to a complete removal of the regime. The healthcare system in Egypt is under considerable stress. Cairo alone has a population of around 20 million. Yet when my husband went to a public hospital in Cairo with a broken collarbone, he was seen by doctors and could have had an operation done the following day had he stayed.

I’m still trying to understand British politics. The NHS is mentioned frequently in the news and by politicians. The message I am getting is that the problems I am experiencing with the British healthcare system are not the exception. All the problems I have experienced thus far have nothing to do with individuals, and everything to do with a system that does not appear to work.

I have a medical degree. I am a science writer by profession. I will not claim to know better than doctors who have practiced medicine all their professional lives. But my background and current experiences with the NHS do allow me to begin to develop the inklings of an opinion. And that is to wonder whether Britain’s healthcare system is in dire need of a revolution.