Underusing the NHS
This was a conversation I had with my sister (Akka) around the middle of 2019
Akka: Want some tea?
Me: Nah, I'm good.
Akka: Didn't you used to like tea?
Me: Yeah, I do but I can't drink hot things because of a mouth ulcer.
Akka: Wait, didn't you say the same thing a few months ago? You got another ulcer?
Me: No it's the same one, I've had it for a while.
Akka: You should see the GP (General Practitioner) about that.
Me: Yeah, one of these days, if it doesn't go away on it's own.
I didn't see the GP. I just waited for it to go away on it's own, which took another year. So for approximately 1.5 years, I didn't drink anything hot. Although I missed hot drinks, I felt like it was too much hassle to use the NHS for something that would go away "any day now". I just drank cold milk instead.
But to understand why I wasn't seeing the doctor, let me tell you about my experience with the NHS in the last few years
The wisdom tooth
In August 2017 I was experiencing some discomfort near one of my wisdom teeth. I figured it was probably because of a cavity that I'd eventually get filled at some point. However it got progressively worse to the point where I was in agony. It felt like my entire skull was hurting. I simply couldn't sleep anymore because the pain was keeping me up.
I couldn't put it off anymore so I called the NHS to ask for an appointment to see a dentist. They told me the first available appointment was a week away. I couldn't believe what I was hearing. I needed a doctor now and they were telling me to wait a week? I asked them if there wasn't some other way. They told me I could call an ambulance and someone in the emergency room would take a look at me. I considered it, but ultimately decided against it. The ambulance is for people who've suffered heart attacks or car accidents, I thought. Not tooth pain, no matter how bad it is.
I spoke with someone from work who told me to get seen by a private dentist. I called them up and got an appointment the same day. The dentist found that my gums near the tooth had become infected. They cleaned it up as best as they could, prescribed me anti-biotics and recommended I get the tooth extracted.
I was given the option of a private dentist in a week, or the NHS dentist in 3 months. The private dentist would cost £350, a quarter of which would be covered by my employer's dental plan. The NHS would be free. It was a no brainer - I needed it extracted ASAP.
This was my first experience with the NHS. I reflected that I had probably been wrong to not make an appointment as soon as I was in mild discomfort, so that I would have had an appointment in case it deteriorated. But if it had cleared up on it's own, I would have felt like a muppet for wasting their time and mine. Also, if I had known that I had an infection and it was getting worse, I would have called the ambulance and gotten seen immediately.
In September 2019 I got a serious case of the flu. Normally I recover within 48 hours, but when I remained ill after 4 days, I decided I needed to see the GP. I called them up and asked for an appointment.
Me: I'd like an appointment to see the GP.
Receptionist: Are you registered with this surgery?
Me: No, can I register now?
Receptionist: Yes, but you have to register in person.
Me: Ok, can I register today?
Receptionist: Afraid not. The earliest appointment for registering is 3 days from now, on Friday.
Me: Ok, can I see the doctor the same day after I register?
Receptionist: No, the earliest you can see the GP is 3 weeks from now. You can request an appointment after you're registered. Or you can call in the next morning for an appointment. There are a few same day appointments.
Me: So I can call in Saturday morning?
Receptionist: No, we're closed for the weeekend. You can call Monday.
I felt I had no choice. I remained sick for another 5 days, 9 days in all. I registered with the GP that Friday and went home without seeing a doctor at any point.
A friend later told me I should have gone to the emergency room and someone would have had a look at me within an hour or two. But I felt I shouldn't block up the emergency room with a trivial complaint when people with serious issues probably needed care more. I'd get better within 48 hours, I kept telling myself delusionally.
In hindsight, after realising the Kafkaesque way surgeries handle registrations, I should have registered in advance. I should have spammed the phone lines at 7:55am to get that coveted same day appointment, although this is far from fool proof.
Wax in the ear
This is trivial compared to the other two incidents, but lasted much longer. In October 2019, I found that I couldn't hear as well as I used to. When I slept on my side (ie, every night), I found that ear became blocked for the rest of the day. This was uncomfortable, but I was hopeful that it would sort itself out. (Are you seeing a pattern here?)
When it persisted, I decided to see a GP. Fortunately, I was registered now! I got an appointment for 3 weeks away, the earliest one available. I was giddy with excitement when the day arrived, like a kid anticipating a birthday present. I'd finally get my ears unblocked!
I see the GP half an hour late, despite being the second appointment that day. When I get in, the GP took a cursory glance and confirmed that my ear is blocked and the wax appeared hardened. They tell me to use olive oil to soften the wax and it'll clear up on it's own.
Olive oil? Yep, olive oil. I asked if there wasn't any alternative treatment possible, like actually removing the wax. He assured me that olive oil was the way to go, but if I really wanted, he would prescribe some ear drops. The NHS didn't do ear irrigation anymore, he said.
I A/B tested the two treatments - olive oil in the left ear and the peroxide based drops in the right. It seemed like olive oil was ineffective and the drops were reasonably effective. It required some digging with a tissue paper, but the problem was solved. Or so I thought.
The problem recurred a year later, in December 2020. This time I didn't need to see the GP again, I could just use the drops. But when I did, it just made the block worse, and it made my ear hurt.
I had learned my lesson. I didn't rely on the GP who'd take 3 weeks to see me and fob me off with olive oil. I registered with an online GP service who saw me the next day, confirmed the issue in 6 minutes and referred me to a specialist. The treatment would be covered by my employer provided insurance.
Comparing the NHS with treatment in India
I lived all my life in India before moving to the UK. I had grown to trust the doctors who treated me. They were professionals who had only my best interests at heart. I told them my symptoms and followed their directions. I didn't second guess their diagnoses or treatment plans, because I knew they knew better.
My experience with the NHS has been different. It felt like the doctor I saw was more skeptical of what I was telling him. I tried to explain how much discomfort I had been in for months but I think he suspected me of overstating their symptoms, trying to overuse care I didn't need. It felt like he cared more about saving the NHS's money than providing me care.
This is why I didn't see any doctor despite suffering from a painful mouth ulcer for more than a year. I just didn't see the point. It would take weeks anyway, and then I'd probably be told to apply yoghurt or snake oil on it. Better would be for it to heal on it's own. And truth be told, after I eliminated hot drinks from my diet, I was only painfully reminded I had an ulcer when I bit on it by accident.
I think that's the difference when you're paying for medical care vs when you're not. Since it costs nothing, patients might see doctors even when they don't need it. Now the doctors have to be on guard, to make sure that no one is overusing care they don't need, just because it's free. This was never an issue in India, because every transaction I paid out of pocket.
If I ever the misfortune to see the GP I mentioned earlier, I'll be sure to advocate harder for myself, even if it means second guessing their judgement.
I support the NHS
Despite all this, I still support the NHS and taxpayer funded medical care. Yes, I did not get any worthwhile medical care despite paying tens of thousands of pounds in taxes to the NHS. However, that's how taxes work. You pay for a better outcome for society, not just yourself.
Society is better off because no one is going bankrupt because they can't pay their bills. No one with cancer has to make a tough choice between living and leaving their family with more money. No one calls an Uber instead of an ambulance to save money. Anyone who really needs a doctor will be able to see one.
Overusing and underusing the NHS is a well known problem, not something I've independently discovered. Many smart people are working on it and I respect them and their efforts too much to add a "why don't you just" solution here. You can read more about it here.
Also, my experience is just a few anecdotes, with one GP in London. GPs outside London aren't so overburdened and can see patients without lengthy waiting times. It's also very likely that other GPs aren't olive oil salesmen and actually listen to their patients. We should not judge an entire system based on the experience of a single person with a single GP.
And yes, I got stellar medical care in India, but what I failed to mention is that my parents were among the 0.1% of wealthiest Indians. Any family earning more than ₹10 lakh (£10k) a year is. My experience was great, but it was not what the vast majority of Indians experience. Often, they might not be able to afford doctors, might not live near doctors and might be forced to see quacks.
All people deserve good medical care, and if that means that people like me contribute more via taxes than we receive, then so be it. Society is better that way.