'GPs have got Britain hooked on painkillers'

today's Observer screams. Well, excuse me.

Could it be something to do with the lack access to health services in the country? When someone has a pain and is sent away with painkillers (oh for god's sake, don't use any diagnostic tools!), after three months is finally sent for an x-ray, the results of which she waits for a month for (how difficult is it to look at an x-ray?) and she is given by the practice receptionist - surely a breach of protocol, and then she gets an appointment to see the GP almost four weeks later....moving to almost 6 months after this all started.... I'd like to nail that healthboard to the wall!

So GPs have got Britain hooked on painkillers? (Which must also mean a number of accompanying complications in the stomach department).

Has anyone thought of curing people, rather than maintaining them in the poor state of health they are? If they are of working age, such negligent 'treatment' (how can you call it 'treatment') could cause all sorts of consequences starting with loss of job. But people beyond working age have the same entitlements as those who are still working.

The health spending in Scotland has doubled in the last 7 or 8 years. Has it had any effect? A crisis is already developing in child surgery where many surgeons will retire in the next 10 years. What's being done about this? Maybe there are more managers?

How come this is an Eastern European blog and I keep having to complain about the UK?

Health care Lithuanian style (Public Department)

A few days ago a new baby was carried into the flat below mine. So when today at my desk I heard some crying noises from downstairs I was only a little surprised. Did not think a new baby would make enough noise to penetrate our thick walls. Also the rhythm did not seem quite right, but maybe I did not know anything about my neighbours and there was an older child. But it was not an 'I am being killed' kind of noise.

Much, much later, the noise had gone and come again, I went out, and in front of me went 'the noise' and a lot of people talking. Sounded a bit older - maybe the child was being taken to the doctors?

When I got to the bottom of the stairs I found the source of the noise. A woman of indeterminate age, 40s upwards but difficult to tell, was obviously in a lot of discomfort and had been taken out of the flat into an ambulance. Not on a stretcher, nicely wrapped up. Not on a folding chair that might go around the bends in the stairs, nicely wrapped up. On what looked like a tarpaulin with handles - presumably what they use all the time - absolutely not wrapped up, midriff showing, that kind of thing. No idea what was her problem, but imagine being on effectively a soft sack, and you have broken your hip or something. I heard people around her saying that they had waited for an hour for the ambulance (sounded longer to me, but maybe a doctor had been first). Given that the ambulance then shot off like a bat out of hell, with blue lights and sirens blaring, things obviously were not well - though at least the lady was still capable of making a noise.

But really, where we live there is no reason why an urgent ambulance can't be here within 20-30 minutes, unless there is no ambulance available. So that's how the public sector health service works?

Aaaaaah - Lithuanian Hospitals!

I can't really compare hospital care between Germany (34 years ago), the UK (29 years ago, during the winter of discontent with the porter and auxiliary strike and petrol shortages) and Lithuania (this week), when the last one was a private hospital, too, but it might be nice to take the frighteners off medicine in Eastern Europe.

Needs to be said, though, that I'm also insured through the state health system in Lithuania. Not sure how the cooperation between state sector and private sector works in Germany, except that private patients go to the normal state hospitals. In the UK people go to the private sector and pay for everything, or sometimes, when the state sector is in Big Trouble trying to meet its multifarious targets, the state pays for them to go private (or abroad, though usually like a state patient of the foreign country).

In Lithuania, for about the last year or so, the state health insurance had drawn up agreements with certain private health care providers whereby the state pays a share of the costs (maybe what it would normally pay in its own system for the treatments that the state system provides?). This is kind of cool, and keeps the private costs quite low for those of us who pay the state, too. It's a bit bizarre, too. In Lithuania people are still quite happy to pay the doctor, nurses etc a considerable 'bonus' 'under the table' for their treatment, the so-called 'informal payments'. Apparently you ask the doctor how much you should pay, and some tell you the sum, others let you guess. I remember a friend paying 200 informal Euros to a doctor in for a nose operation in the state sector (how complex can that be) - this week I paid less than this, formally, for a small abdominal operation, including hospital stay of one night. The Health Ministry, or at least the last Minister before he disgraced himself over a car, was firmly against the system of informal payments, but in a discussion after his speech, the potential payments thought that the doctors deserved these payments. If you are a Lithuanian needing fairly predictable and plannable hospital treatment, I would want to compare the costs of private treatment (in a hospital with an agreement with the state) with the costs of state treatment plus under-the-table bonuses. Probably if you live in the deep countryside you don't have that choice.

One of the problems of private treatment, though, is the fact that many of the highly specialist doctors have 'day-jobs' in the state hospitals. It's kind of high-prestige-low(?)-income in the state hospitals, and almost the other way around in the private hospitals. As a doctor, you probably get the more interesting cases in the state hospital. Their day jobs have to be completed first, so they come round to the private hospitals in the afternoon/early evening. I wonder if they have an 80/20 arrangement like doctors used to have in the UK NHS? If you have to wait for your specialist for assessment prior to discharge then it'll be early evening. I wonder what would happen if you had a sudden catastrophe in the morning? There are permanent staff grade doctors around, but what would they do? Perhaps the most complex cases which need most supervision by the specialist might not be done in a private hospital?

In the case of the clinic I used everything was included in the price; it was not xx lt for a blood test, or yy lt for a pill for something unexpected. That was really great. The quality of care was wonderful with the nurses doing everything they possibly could for me, extremely kindly. The one thing that surprised me a little, having worked in a British hospital over 30 years ago, When They Were Still Clean, was that while I was not allowed out of bed for 24 hours no-one came to wash me or change my bed (I know how to change a bed with the patient in it). By the time I realised I had missed this I was almost able to get up again. Maybe that is what people say of Lithuanian state hospitals - that the relatives have to provide the care. But overall, the care was fine for me, and I especially like the plates of fruit that appeared mid-morning and mid-afternoon. No cups of tea, though.

If you are a foreigner and thinking of getting private treatment (with or without state support) in Lithuania, though, get a Lithuanian-speaking friend to look at the Lithuanian version of the clinic's website. Often this has very different information from the English website - the Lithuanian version often includes a price list, too. That's really useful to have. Also useful is a list of the doctors which you can then check out in the internet for publications, research interests, their day jobs etc.