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A tale of two coughs



I retired from the NHS in 2002 and, having spent the previous 20 years caring for my wife’s and my own parents, my wife and I decided to emigrate to the warmer climes of Cyprus when the last surviving parent passed away. ‘Why?’ shouted our children. ‘Who is going to look after you?’ The answer was fairly straightforward: we were going to spend a few years looking after ourselves in an environment we had dreamed of but had never  been able to take advantage of.

Of course we researched the facilities available on Cyprus in great detail – particularly the Cypriot Health Service which, as members of the European Community, we were entitled to take advantage of.  But what we heard was not encouraging; virtually non-existent GP services (Cypriot GPs spend some 70% of their time writing repeat prescriptions), a 1950s style ambulance service with very few paramedics and a casualty service where 8 – 10 hour waits were commonplace. The ticketing system in outpatients was a bit exasperating when number 57 is being seen and you are number 423 – and so on, so forth.

The answer was to take out a private health plan in the UK, which would cover us both at home and on the island, and where we could avoid the queues to get the treatment needed. Of course, being from a medical background, we knew what speciality to refer ourselves to and, apart from somewhat outdated ideas (post hip replacements one must spend three weeks resting in bed),  lack of equipment and  treatment (sorry, only one type of statin available on the island and if you want 50mg of metoprolol you cut the 100mg in half), we have managed very well.

But, I digress from the title of this short article – a tale of two coughs. A neighbour here on the island developed an irritating cough – non productive and she was not ill in herself. After two weeks of listening to her cough I advised her to see a chest physician. She did and, as she was covered, she saw him privately within 48 hours . Chest X-Ray, CAT scan and bronchoscopy, biopsy – and all within a further 48 hours. The diagnosis? A very early small cell tumour of the right upper lobe.  Just five days later she was being discharged, minus her right upper lobe and with a string of follow up appointments.

Let us move onto friend number two who lives in the UK and who also developed an irritating cough. Again, I urged her to see a doctor who, after listening to her chest, diagnosed an infection (cough was non productive and she was not ill) and prescribed antibiotics. Six weeks later and after a further three courses of antibiotics, she was referred for a chest X-Ray which didn’t show anything untoward.  Another four weeks passed,  two more courses of antibiotics and the cough was getting worse. Referral to a chest physician took another three weeks, a CAT scan showed nothing and three weeks later again, in she went for a bronchoscopy.  The result?  A well  developed  small cell carcinoma hidden behind the clavicle. The fallout from this has yet to emerge.

So, what have we? Friend number one in Cyprus who opted for private medicine (€7600 to date)  who went from initial cough to ongoing advanced treatments in just over three weeks. Friend number two, with very similar original symptoms, and under the British NHS, went through a similar scheme of events in a staggering 17 weeks.

I am not going to try and compare the advantages of the Cypriot (or UK) private system over the disadvantages of the British NHS. Indeed, the NHS is profoundly superior when it comes to immediately necessary treatment and ongoing care once a condition has been identified. The problem lies in making the initial diagnosis. Here in Cyprus (and in the UK) on the private front, money talks and under this system, the physician is naturally inclined to ‘over investigate’ and treat within the shortest period of time. Conversely, under the NHS, the ‘try this first’ attitude of GPs, the reluctance and cost to the practice budget of rapid referral and the hospital waiting list ogre (no matter how short) means that rapid diagnosis and treatment is incredibly difficult under the NHS.

So, how would similar situations be managed under the Cypriot NHS? To go to a Cypriot GP is a pointless exercise because direct referrals are no go. Ask the GP about a persistent cough and he will tell you to present yourself at the casualty department. There, a wait of hours ensues before you are seen by a casualty officer. But this is where the situation changes. A persistent non productive and non infective cough is immediately referred to a chest physician who almost automatically admits the patient for investigation. The patient would not then leave the hospital until all investigation and treatment is complete – no matter how long it takes.

And so there you have the tale of two coughs. As I have already said, I am not going to try and compare the advantages of the Cypriot (or UK) private system over the disadvantages  of the British or Cypriot NHS but, if given the choice, I think I know which route I would like to take.

Dr Barrie Davies is a retired GP and lives in Cyprus.