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4 February 2002

The ex-GP’s tale

NHS in crisis - The ex-GP's tale

By Phil Hammond

One of the downsides of being a media doctor is that it catches up with you in the end. For ten years, I’ve been telling patients to stand up for themselves, put doctors to the test and take responsibility for decisions about their health, safe in the knowledge that I try never to go near the NHS. I did have meningitis (thankfully viral) six years ago, when I wasn’t in a position to ask the doctor with the lumbar puncture needle how many he’d done before, what his results were and how they compared with the national average. My headache was so bad, and my neck so sore, that I just took what I was offered.

I’ve been fit and well ever since, but in the past few years, my relatives have started falling to pieces. Having just recorded a “life-saving” episode of Trust Me, I’m a Doctor on the importance of dialling 999 quickly for severe chest pain, I was told that my superfit stepdad had sat up watching the Olympics for several hours with chest pain. He’d hoped it was indigestion, then tried phoning the GP, then got a nurse on a decision-support programme who took another hour to phone back and decide it could be a heart attack. By the time he got to hospital, he had thrombolysis.

He was found to have very severe triple vessel disease; the doctors urgently recommended that he have heart surgery. Alas, the urgent NHS waiting list is anything but, so we go for private surgery in an NHS hospital. And just to make it interesting, it’s the Bristol Royal Infirmary, where I first exposed the failings of heart surgery in Private Eye ten years ago. We walk on to the ward and a nurse clocks me and says to the surgeon: “You know who that is, don’t you? You’d better not f**k this one up.”

Fortunately, the Bristol unit now publishes its results on the web, and the surgeon was only too pleased to offer up his own figures for scrutiny. He said he would do this for anyone, but very few patients ask. When your heart’s on the line, you prefer to opt for the armour-plated reassurance of blind trust.

The surgery went well, the staff were brilliant, but the facilities at the infirmary still leave a lot to be desired. For example, the angio suite is on the opposite side of the road to the recovery ward. So if a patient suddenly blocks off an artery, the nurses have to put him in a lift, do an It’s a Knockout dash along an underground tunnel, and then it’s up in a lift to get him sorted out.

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My dad sailed through and was nursed back to health by my mum, who then discovered a breast lump. It was off to Bath on the NHS this time – after going on the internet and downloading an audit from Avon Health Authority attesting to the unit’s expertise. And once again, the staff were excellent but ludicrously overburdened. Fortunately the tumour, although aggressive, had not visibly spread at the time of surgery.

Then comes the really difficult shared decision-making – do you want chemo-therapy to slaughter your bone marrow now, in return for a small percentage increase in your chances of survival in the next ten years? Again, the consultant was supportive and skilled in explaining the likely benefit versus the potential harm, and put it all in writing. Were we getting special treatment? I don’t think so – we just asked.

Within months, I’m back again at the no-star Bristol Royal Infirmary, this time to the casualty department with my wife. It’s absolute mayhem (we do at least get a trolley), and I ask a nurse what he thinks about the no-star status. “To be honest, we quite like it. No stars means no expectations.”

The surgical registrar on call can’t come round for nine hours because she’s in theatre all day doing a routine list. On the ward, the nurses are really friendly, but the Spanish and Italian ones are hard to understand. After 48 hours of my wife being kept on fluids without anyone deciding what to do, I finally lose it and phone the consultant’s secretary. He comes round swiftly and pulls out all the stops. I may preach assertiveness but I still find it uncomfortable to do. Yet what must the service be like for the poor sods who can’t stand up for themselves?

As for my life as a doctor, I’ve swapped general practice for sexual health medicine. I liked being a GP, but I only have time to do a few sessions a week and, despite all my public bluster about doctors’ competence, I looked myself in the eye and decided I wouldn’t want me as my GP – so why should anyone else? The job is too important and complex for media tarts to dabble in for a day a week, and so I’ve chosen a specialism where I can stay up to date and be competent.

Confidentiality is paramount in sexual health, but it works both ways. As one consultant put it: “The great thing about this job is that you don’t get many complaints. I’ve never known anyone write to the Times about the appalling treatment of his genital warts.”

Everyone is anxious on the way in, but effusively grateful on the way out. Just like general practice used to be.

Phil Hammond’s series 28 Minutes to Save the NHS starts on 6 February at 11pm on Radio 4