Samizdata

Yesterday I sent out a mass email to a list of my nearest and dearest, as many of them whose names I could remember, telling them that, just before Christmas, I had been diagnosed with lung cancer, and you know, pass it on. I said how bad I thought it was, and it does indeed seem rather bad. And I said what they could all do to cheer me up. Basically, tell me and tell the world what a clever fellow I have been over the years, and what their favourite writings and activities of mine have been. This process is now well under way, and a very gratifying boost to my morale it has already been, morale when faced with cancer being, I surmise, a rather big deal, maybe even a life-saver. My thanks to all those who have already communicated with me along those lines, and long may that process continue.

I put the entire text of that email up at my personal blog, and should you now wish to, you can read it there.

What else to say? Many things, not least that this diagnosis has concentrated my mind wonderfully on what really matters to me. During the last few years, I have found myself writing more and more about trivia and esoterica, of the sort that intrigues me but lacks general appeal, at my various personal blogs, rather than trying to grab the world by the ears here at Samizdata. Although I promise nothing, I now feel that this is liable to change. My life now looks like being too short to be postponing the final bits of ear-grabbing that I now want to try to get done, before I depart. Famous last words are hard to contrive, but some rather more impressive ones than would have happened had I merely died suddenly now seem worth attempting.

I’ll make a start by writing about a phenomenon I have become very aware of during the last few days and weeks, which is the imbalance between the effectiveness of Britain’s National Health Service when it comes, on the one hand, to the diagnosis of a disease, and on the other hand, to the treating of it.

Basically, the NHS does the first very inefficiently and in particular very slowly. But, it does the second really rather well, often just as well or better than the private sector, and often with the exact same equipment and staff.

My understanding of this contrast may be distorted by the fact that I am now being treated, at the expense of the NHS, at London’s Royal Marsden Hospital in the Fulham Road, which has a global reputation for its cancer treatment. But, in not a few of the sympathetic emails I have received from friends and relatives, this same story has recurred, of slow and unsatisfactory NHS diagnosis, then followed by a vigorous, urgent and targetted response to the problem, once that problem was properly understood.

The email which explained this best came from my sister, who was an NHS General Practitioner for all of her working life until she retired.

The problem faced by the NHS in diagnosis is that the NHS is confronted on a daily basis with an ocean of complaints about aches, pains and general misfortunes which can be anything from very serious to hardly counting as real medical problems at all. NHS general practitioners provide a service which stretches all the way from trying to spot something like my lung cancer, to just lending a sympathetic ear to a person who is being tormented by her husband or children, or just generally feeling glum and run-down. The service is free at the point of use. If you are having a miserable life and could use some pills to take the worst of the sting out of that life, and if you would positively welcome waiting in the queue at the doctor’s, thereby enjoying a little moment of blessed relief from the disappointments or even torments of the rest of your life, well, you would visit your doctor, wouldn’t you?

The National Health Service doubles up as a sort of National Friendliness Service. At which point, how is the doctor supposed to decide who he or she should spend serious time with, in this vast and varied queue, and whom he or she should shove to the back of the queue? How is the doctor supposed to spot the serious medical cases, in among the vast throng of the merely unhappy and unfortunate? I’m not blaming these NHS doctors for their problem. They’re doing their best. It’s just that their best is liable not to be that good.

So it is that the NHS takes a huge amount of time to identify the serious cases, such as mine is. A pain in your pelvis, you say? Quite bad, you say? Well, I suppose you could have a test, towards the end of next month. Maybe an appointment with a bone doctor, in January? Would the 21st be convenient? Our budget is rather limited, as I am sure you realise, and time slots soon get taken.

Faced with this interminable process, while my aches and pains gradually got that little bit worse as the weeks went by, I eventually sought the informal help of medically expert friends. Who immediately advised me to go private to find out what the problem was. Sounds like it’s serious, they said. They recommended a trusted private sector GP, who talked my sufferings over with me on the phone within about one hour, and immediately steered me towards an esteemed colleague. I put myself in this colleague’s hands. I did not and still do not have any private medical insurance scheme. Nevertheless, for the price of a cheap second hand car, I then learned the bad news of what was happening to me in a matter of days. In no time at all, or so it now feels, I began to be treated at the Royal Marsden, for the immediate threat to my spine, which is just next to where the tumor is.

I soon realised that what I had paid for was not just a diagnostic expert, but also an advocate for me, within the NHS system. That advocate could lay out the evidence in front of the NHS. Look, this is serious. Treat this, and you won’t just be chucking money at nothing. You will be curing or at the very least seriously treating a serious condition.

I am not trying to make a partisan political point here. I know I know, NHS equals socialism, yah boo hiss. But I think the distinction is a bit more subtle than that. As I say, the serious treatment of serious conditions bit of the NHS seems, if my experience and that of other emailers to me in recent days is anything to go by, to work rather well.

I think the distinction concerns what in other contexts is referred to as “moral hazard”. It is one thing to exaggerate an ache or a pain in order to have a nice little conversation with a nice doctor and to get hold of a few prescription anti-depressants or some such thing, without having to part with any money you do not have because payday is not until tomorrow. But people don’t fake lung cancer merely to get the sympathetic attention of a doctor. I mean, how would you even do that?

I was persuaded by two dear friends in particular that there was almost certainly something or other seriously wrong with me, and I was willing and could afford to reinforce my question with a stash of quite serious cash. I bought my way to the front of the diagnosis queue, and I do not apologise for this one little bit. I bought my way past various merely unhappy and somewhat discomforted people, and well done me. I now have a fighting chance. It turned out that I did indeed need serious medical attention and I needed it fast. My one big regret now is that I did not start waving my money around sooner.

As I say, it was the way that this original surmise of mine was so strongly confirmed by the experiences of others that made me sure that this was something worth me writing about, at the internet outlet I have at my disposal that will reach the greatest number of potential readers. What I’m saying is: Learn from me about how to throw money, in particular, at the diagnosis stage of a potential illness. If your problem proves to be no big problem and is easily corrected, well, fine, you’ve checked it out. Panic over. But if it is a serious problem, chances are you don’t want to be wasting time, and if you have the money, you should spend it and save the time.

Another way of explaining this is to point out that testing for things like cancer can get decidedly expensive, if it is to be done well. Soon after consulting my private sector diagnostic expert, I had about three different tests, each of them costing well over a thousand quid each. It makes no sense to give tests like that to people who are merely unhappy with their lives and their lot in life, and are telling you they have a tummy ache merely to get a little bit of your attention.

Or to put it yet another way, I look forward fondly to the time when such tests get much, much cheaper. Cancer care itself, I have been learning, is massively better than it was even a few short years ago. Well, likewise and one day, I’d like to think that instead of spending half an hour on some unwieldy and expensive space age contraption at the Marsden, there will come a time when all those complaining of bodily misfortunes, however slight, can just step through a gadget no more complicated than an airport metal detector. If the hit rate for serious conditions is a mere one per two hundred, or some such number, well that’s fine. Cheap at the price.

And don’t get me started on Brunel, which is the Marsden’s even space-agier device which has been giving me my first doses of actual treatment. Brunel is really something.

Like I say, my treatment looks like it’s state-of-the-art.

If this blog post saves or merely prolongs just one life, then good. Mission more than accomplished. This has not been that important a posting, and I certainly claim no originality for it. I’m sure many others have noted the same things as I have just been noticing. But, maybe for just one reader or friend-of-a-reader, it just might be the straw, so to speak, that saves one human camel’s back, if you get my drift.

This posting has been written in some haste, hence its rather excessive length. Brevity tends to take longer, I find. Also, I dare say there’s the odd typo or two, which I will correct as and when I or anyone else spots them. But I am sure you understand my haste. I have lots more things I want to say here before I make my exit, and it looks now like I have far less time to waste than I had earlier been supposing.