One GP in London reflects on his experience as an inpatient after a choking episode
I’m writing this blog having spent five nights so far in a London teaching hospital after an unfortunate incident with an oatcake. I will never look at oatcakes in the same way again.
After a very bad choking episode with said oatcake, I ended up in A&E almost unable to swallow any solids. I was hesitant to go to hospital, but as a GP you have to do the same as you’d advise a patient to do – and I knew that if a patient came to see me with the same story, I’d advise them to go to hospital.
Over the years, I have heard too many stories of GPs downplaying their symptoms or ignoring their intuition and then becoming seriously unwell. I didn’t want to make the same mistake.
In A&E, where everyone was unfailingly kind, I was admitted for tests. Unfortunately, dysphagia is one of those symptoms with a huge number of differential diagnoses – some of which can be very nasty – and it comes under several specialities: ENT, neurology, and gastroenterology.
I tried my best not to Google the symptoms but failed. I was trying to work out exactly what was stopping me from swallowing. Could a bit of oatcake still be there? Possibly, but that seemed unlikely. Was I presenting with a neurological condition, such as motor neurone disease or myasthenia gravis? I hoped not, as that would be a pretty bleak outlook.
I saw the exceptional speech and language therapist team in A&E, and she and the medical team told me that I would need further tests. She said if I was discharged, I wouldn’t get them until October, so she told me I should stay. Having now had quite a few tests, it seems I’ve likely got an oesophageal motility problem. Considering all the possible nasty differentials, this seems a relief.
In the 75th year of the NHS, I have been treated with huge kindness and compassion: the hospital staff have all been fantastic, and I haven’t once had to worry about the cost, or whether insurance would cover what must be thousands of pounds’ worth of tests.
When you are unwell and feeling a bit vulnerable, the last thing you want to worry about is money. And luckily, as the NHS is free at the point of access, you don’t have to. But it must remain a publicly funded, free at the point of access health system for all, that is based on clinical need and nothing else.
The same goes for general practice. We can’t possibly charge for appointments or give out fines for missed appointments. That would never work, and patients likely don’t even know they have an appointment a lot of the time. What about missed phone appointments – would they be fined for that, too?
It goes without saying that the NHS and general practice have their faults, and things could be made better. But straying far into the private sector and bringing money into what should be solely clinical decisions? That would be a complete disaster.
As Aneurin Bevan said: ‘Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune the cost of which should be shared by the community.’
Speaking from a hospital bed where I have had superb care by kind nurses, ward staff, porters, cleaners, doctors and radiographers, there is only one word I can say after reading that quote: Hallelujah! And here’s to another 75 years.