[mmarq]

Your mother was quite lucky, the NHS doesn’t do much prevention compared to other healthcare systems. Everything goes through GPs, that are the medicine homologues of a guy that works in IT and can set the background of his Drupal blog. GPs have budgets, are very vocal about it, and would rather run silly experiments for months than writing a referral (the latter impacting on their budget). My girlfriend’s GP wanted to change her birth control pill because it was too expensive, and he has a budget (it’s not a problem anymore, because thanks to Brexit that pill is no longer available in the UK). Children are not assigned to a paediatrician and women are not assigned to a gynaecologist. Women go through pregnancies without ever seeing a person with a degree in medicine, it’s all handled by midwives. If you want access to western medicine you either have an insurance or you’ll have to spend 200-300£ per visit. For some weird reason the NHS has you covered if you need a magician, such as an osteopath, or some magic homeopathic pills.

The NHS has seasons, for instance a few years ago it was chlamydia season and so I was forced to go through a chlamydia screening, but it proved impossible to get tested for any other STD. It is possible that your mother was saved by the colonoscopy season.

[austinjp]

> Everything goes through GPs, that are the medicine homologues of a guy that works in IT and can set the background of his Drupal blog.

I don't follow you. GPs go through specialist training and assessment (general practice is, perhaps paradoxically, a specialism). The comparison you draw seems to be with someone who is unskilled. Can you explain? Perhaps I'm missing something.

While it seems true that GPs are the gate keepers for referral to secondary care, this is largely due to factors that are outside the control of GPs themselves.

I'm not sure I understand your complaint. Do you expect to have direct access to pediatricians and gynaecologists without referral? There simply are not enough of them for that. I'm curious; without being identified as someone who needs specialist care, why would you want access to someone like that? The -icians and -ologists within the NHS deal with specific situations. Perhaps you think you'd receive better care if you simply had direct access to secondary care. Fair enough.... so, that itch you get occasionally, or that nagging ache... are you going to visit the neurologist, or the rheumatologist, or the radiologist, or....?

> GPs have budgets, are very vocal about it

I've literally never heard a GP mention budgets to me as a patient. Or are you referring to GP representation in the media?

> would rather run silly experiments for months than writing a referral (the latter impacting on their budget).

You say that GPs will knowingly experiment on their patients to save money. Are you sure that's what's happening?

> My girlfriend’s GP wanted to change her birth control pill because it was too expensive

Is that actually the reason they gave? Or something you've inferred? Did they, perhaps, want to provide your girlfriend with the service she requested, using what they had at their disposal?

[mmarq]

> I don't follow you. GPs go through specialist training and assessment (general practice is, perhaps paradoxically, a specialism).

You spend 20 years prescribing paracetamol and homeopathy to old ladies and you eventually stop being a real doctor, like somebody who takes a PhD in computer science and then spend 20 years replacing hard disks in a call center.

> I'm not sure I understand your complaint. Do you expect to have direct access to pediatricians and gynaecologists without referral?

Yes, in Italy that is the norm and it sounds silly that you think it’s a weird expectation. That’s probably one of the reasons why the British infant mortality rate is 50% higher than the Italian.

> Fair enough.... so, that itch you get occasionally, or that nagging ache... are you going to visit the neurologist, or the rheumatologist, or the radiologist, or....?

I’m not a hypochondriac, so I don’t go to random doctors on a weekly basis. But given the taxes I pay to fund it, I’m expecting a Western European healthcare system and not this thing that would be below par in a middle-income country.

> I've literally never heard a GP mention budgets to me as a patient. Or are you referring to GP representation in the media?

Sure, that’s what my GP said, she didn’t have a budget for that. I’ve left out the part where I said that it didn’t matter because I had a private insurance and the NHS wouldn’t have to pay for my treatment. At that point she totally lost it and started yelling that the Tories are privatising the NHS and insurance companies are their accomplices or some other crazy thing like that.

> You say that GPs will knowingly experiment on their patients to save money. Are you sure that's what's happening?

Rather than referring my partner to a gynaecologist, the GP kept making up pseudorandom diagnoses for roughly 3 month, until my girlfriend gave up on him and decided to go to a private doctor (it’s not the same person that hates private insurances and at the time I didn’t have an insurance). The private gynaecologist identified the issue in 20’ and prescribed a 3 day treatment that fixed the problem. 3 months of randomness vs 20’ of professionalism.

So, to answer your question, I was being sarcastic: the GP wasn’t experimenting, in the sense that he knew what he was doing, he was just making stuff up to not spend his budget on referrals.

> Is that actually the reason they gave? Or something you've inferred? Did they, perhaps, want to provide your girlfriend with the service she requested, using what they had at their disposal?

My girlfriend had been using a pill for years, after testing a few under the supervision of a gynaecologist (again, that’s the norm in Italy, GPs don’t come up with birth control pill suggestions). Then she moved to the UK and the British GP told her that she should change the pill, because it was too expensive. My girlfriend said she was fine paying for a more expensive pill (in Italy you have to pay for it). Then the doctor went on explaining that the NHS would have to pay for it and that she should use too much public money. I eventually had to intervene, because my partner’s assertiveness is below 0 and the doctor was putting her health at risk to save 5£ per month.

[austinjp]

Your GP "yelled" at you and "made up" random diagnoses to save a few £ per month, deliberately putting your partner's health at risk?

Any GP doing what you say would lose their job and not be allowed to practice again.

My understanding is that you (and maybe your partner) had specific expectations about who you would see and what they would do for you. Your expectations were not met, and you've interpreted this very negatively through some basic misunderstandings of how the NHS works.

> My girlfriend said she was fine paying for a more expensive pill (in Italy you have to pay for it). Then the doctor went on explaining that the NHS would have to pay for it

Despite the fact that you clearly dislike this, it is indeed true. You can't ask an NHS GP to prescribe a specific medication and offer to pay for it yourself. The NHS buys meds and issues them through prescriptions. That's pretty much it.

Just to be clear: I fully accept that not all experiences with GPs are perfect (and neither are all experiences with consultants).

If you want to tell a doctor what you want and have them give it to you, stick to private care. Your opinion of NHS GPs is clearly very low, and unfortunately seems misinformed.

[DanBC]

> but it proved impossible to get tested for any other STD.

You've asked for direct access to specialists, and in England you do have direct access to sexual health clinics where you don't need to be referred by GP, you don't even need to tell your GP, and where they'll test for just about everything.