Public and private distress

The ‘two-tier system’ is often blamed unfairly for issues that arise in the delivery of healthcare

I’ve been lucky during Covid. None of my friends or family needed hospital care for the virus, or for any other reason. That’s changed. The healthcare conversations have started again. A relative had chest pain going into her arm and went off in an ambulance. Because of Covid, her husband couldn’t go with her. In the emergency department she was triaged and a cardiac event was ruled out. Happy? No! She spent a miserable night sitting in a chair, cold and sleepless. Meanwhile, he was worrying that she hadn’t been seen, when actually she was waiting for results.

A first-time mother planned a home birth. She didn’t want Covid rules to stop her husband from being with her and the baby. But baby came feet first, so she had to have a caesarean section. Mother and child are both well. Isn’t that great! No. She was not happy – the nurses left her to change the baby herself. If only she’d been in a private hospital came the cry! They were surprised to hear that “private” doesn’t necessarily mean extra nursing. I find the “two-tier” system often gets blamed unfairly.

Hospitals are hard on patients. Years ago, after urgent eye surgery, the doctors suggested I was fit for early discharge. I didn’t feel ready, but I said nothing, until a nurse said quietly “Don’t rush out”. The hospital team have to focus on tests to exclude a heart attack, making sure mother and baby are healthy, checking that my eye healed post-op. But a miserably cold night isn’t good for anyone’s heart. A new mum may need the reassurance of help with her baby. In my case, one more night made a big difference.

Twice recently, I’ve had to tell friends: “Please stop being so nice to your doctors.” Yes, doctors are very busy. Yes, they have to reduce contact with patients because of Covid. But they still want to hear your problems. One friend attends a number of consultants privately. Due to Covid, it’s all on the phone. The doctors couldn’t see he had aged years in a few months. He presumed his distressing symptoms were inevitable, didn’t want to trouble his doctors. Then it emerged his problems vanish on Difene. “Take the bloody stuff,” I said. No, he replied, his doctors warned him it was very risky. I told him to book an appointment and explain how wretched life had become. When we next met, he looked years younger. His doctor said exactly what I said: “Take the bloody stuff! Life is for living.”

The other person wanted a recommendation for a private clinic. Following life-saving surgery some years ago, a public clinic monitors her blood tests and checks her medication. Due to Covid, of course she meets no-one. The doctors just want the blood tests, they didn’t even ask how she feels. If they did, maybe she’d have mentioned her symptoms. “Make a list,” I said, “Doctors hate lists, so make it short.” Later I went Googling and saw her complaints were all recognised side-effects of the tablet. It was stopped at the next appointment.

Long before Covid, I’ve had healthcare conversations, sometimes with near strangers. There was the consultant in a public clinic who said he would call security if the patient didn’t leave. I don’t really know what happened, but over the years, I’ve learned that anger from patients or families is usually a front for anxiety or fear. This man was terrified he had cancer. Furthermore, a friend of his had similar problems and was being treated for advanced cancer. The friend had health insurance and he didn’t. It took a long time to explain that his care was entirely appropriate, nothing to do with the “two tier-system”.

A man said he was thinking of making a complaint to the Medical Council. Why? The nurses were wonderful during his wife’s cruel illness and inevitable death, in a private hospital. However, the consultant caused her needless distress in her dying days, by persisting with futile treatments. As we talked over the truly difficult and tragic choices involved, because of their young family, I realised he thought the consultant didn’t care. Why? Because the husband was left waiting for hours for the consultant to arrive from the public hospital. That happened twice. Trust in the doctor was lost and now he doubted the treatment.

These people are all smart, educated, articulate. Some are health professionals. The discussions are rarely simple, rarely brief. It takes a long time for the important details to emerge. I hope I helped a little and I think I did. Maybe these conversations are my contribution to healthcare. Maybe they are my penance.