INTERNATIONAL: Medpundit in another foolish attack on the NHS

It’s been a while since I took at look at what Syd has been saying over at Medpundit, but I picked up a couple of gems recently.  One gave Syd the chance to attack those damn socialists in the UK who apparently don’t do preventative screening the way she thinks they ought to. She manages to extract from an article in the Times which broadly agrees with the BMA’s criticism of whole-body scanning and other "excessive" screening, that the UK is not doing screening for diabetes and high cholesterol, (although she thinks that it must be somehow) and pretty soon that gets lumped into some random reader’s comment about having to wait 2 months in Canada for a diabetes test.

I know that these are just the random thoughts of a conservative doctor who hates socialized medicine, but Jeez, Syd–can you give it a rest for a second?

First, the really comprehensive study of primary care in five English speaking nations done last year did indeed show that the US did slightly better in preventative screening than the other nations, but it didn’t do that much better and on an absolute basis we’re not doing that well–(here’s the detailed chart). But overall we did pretty damn poorly in comparison to a bunch of health systems that spend a whole lot less money, including by the way in such measures as waiting times for primary care, coordination of care between doctors, and of course having the poorer among us to avoid necessary care because of the cost.  So taking one measure in isolation to bash the UK’s NHS and then to take one anecdote to extend that to Canada is just sloppy.

Secondly, there’s more to primary care than preventative screening–there’s treatment of the chronically ill. UK GPs are now actively compensated on the rates of their patients who get recommended treatments. We know from Beth McGlynn’s RAND study that only about half of American patients get the recommended treatment, so I’m prepared to bet that that number is now higher in the UK.

Thirdly I visited two GP practices in the UK early last year. Both were very typical and both did something that I suspect almost no American clinic can do. The first was able to tell me immediately how many of its patients were on certain drugs and be able to break that down by those patients’ demographic groups and health status. The second has a Wednesday each month when one afternoon was devoted to eye and feet exams for all its diabetic patients, who are called into the office when a nurse team checks them out. And because they had a functioning EMR, they knew who all the diabetics were. In the US we have a whole mini-industry that mines claims to try to find out who the diabetics in a health plan are, and I can assure that they can’t just call the doctor’s office up to find out–because no doctors office using a paper chart can possibly know.

Now to her credit, Syd has been putting in an EMR and she probably soon will be able to answer those types of questions, but she shouldn’t be quite so hasty in slagging off those Brits who’ve been showing us how it’s done just because she has an irrational fear of the socialized medicine bogey-man.

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2 replies »

  1. Matthew, all is not well in family medicine in the UK because GPs are having to chase government targets which have little to do with health care. But, yes, diabetic primary care is good

  2. Hmmm, I’ve never been screened for anything. Do you think Syd will do this for free?