UK Health System Is Unique, Yet Similar

Colin T. Son


June 09, 2009

The United Kingdom's National Health Service is the world's largest publicly funded healthcare system. It is distinct even among other health systems of industrialized nations that guarantee universal healthcare. Its inner workings, and especially its failings, are chronicled regularly at The Jobbing Doctor, an entertaining and informative blog written by an anonymous general practitioner who also identifies himself as a husband, a wine connoisseur, a cellist, and an Aston Villa fan (although we won't hold that against him).

At times, The Jobbing Doctor is uniquely British, both in content and in tone. In one recent post, the author employed his dry British humor to denounce the usefulness of blood tests in treating a patient with thyroid disease:

I love my job. I sit and listen to peoples' stories and try to make sense of all their problems amidst a sea of irrelevant or minor symptoms.
Sometimes I get confused, and blood tests frequently don't help at all...
Well, I was very confused the other month, when a lady turned up with a highish TSH and T4 and a normal T3.
Now that doesn't make sense to me. I spoke to a colleague at the hospital and it didn't make sense to her, either!
So I did what Jobbing Doctor is best at........nothing.
After a month I saw her again, and she is pleased I hadn't changed her treatment. The reason was that she knows she's on the right treatment, as her legs have started to get hairy again, and her eyebrows are growing.
Pah! Who needs blood tests!
The Jobbing Doctor hosts Grand Rounds
June 7, 2009


Just as often, the blog highlights the universal experience of providing healthcare anywhere in the world, such as when the author recently discussed the stressful interactions between primary care physicians and the specialists to whom they refer their patients:

I had [a letter] this week from a rheumatologist, and it was about a patient with Rheumatoid Arthritis and Gout. I referred him for management of the former with what are called DMARTs [Disease Modifying Anti-Rheumatic Treatments]...
The letter I get back repeats the history of his illness that I detailed in my referral letter. Don't mind that. Tells me clinical findings, test results and plans for medication. That's OK too.
But then I get these lines in the letter: "this man's blood pressure is poorly controlled - needs to be controlled better. He also has a very high cholesterol. Please will you treat."
Now, I'm sorry, sunshine, but you stick to looking after his rheumatoid arthritis. He doesn't have high blood pressure because your nurse measured it high on one occasion in your clinic. His BP has been excellently controlled for 8 years by me.
The second comment pisses me off even more. The absolute figure for total cholesterol is one of many factors that need to be assessed in determining cardiovascular risk. The rheumatologist is clearly not aware of the Framingham Study, which determines whether healthy people need their cholesterol reduced by drugs. A cholesterol of 6.3 mmol/L (243 in USA) is OK for this bloke, and in another chap one of 5.2 mmol/L (200 in USA) may be too high.
I know better than him, so I am writing a letter to him to educate him in these little details. I have done the first draft, and will apply the 24-hour rule - don't send anything for 24 hours and read it again so that you don't send too emotional a response.

True, The Jobbing Doctor is nothing if not opinionated, but that is what makes the blog so enjoyable to read. And this week there is a special reason to visit this blog, as it serves as host for Grand Rounds. Grand Rounds is the "CliffsNotes" of the medical blogosphere, offering a weekly sampling of blogs written by physicians, patients, nurses, pharmacists, students, and others.