I had a mammogram today.
I’m three and a half months short of my 55th birthday and this is my second mammogram. In England you don’t ordinarily get on the National Health Service list to have one until after your 50th birthday and then you get one every 3 years. You are not allowed to “top up” by paying for intervening years. (It’s the same with cervical smears which also are only available every 3 years.)
Once you hit 50 you will be invited to attend (as they say) the next time the breast screening unit comes to your area. In my case that didn’t happen until I was 51 and a bit because I live in the middle of nowhere. I got a letter telling me that an appointment had been made for me at the mobile unit which would be parked outside my local GP’s office. (My GP is practice is determined by where I live.)
I telephoned and asked if I could please have my appointment at the main hospital instead, in the city where I work, so I didn’t have to take almost half a day off to drive the 45 minutes back home in the middle of the afternoon. Or perhaps I could have an appointment first thing in the morning or last thing in the afternoon? None of that was possible, it seems. Breast screening is linked to GPs and GPs are linked to where you live. (I’m not allowed to have a doctor in the city, because that is too far away.)
Last month, almost three and a half years after my first mammogram, because that was when they got around to me, I got a second letter. This time I did have to change the appointment because I wasn’t even in the UK, but I took the only alternative they offered me. I knew it was no good actually trying to find a time or place that was convenient.
You do not see a doctor when you have a mammogram. A technician takes the films. As before, the technician — not the same person I saw last time — explained to me that the films could not be read on the spot, so I might be recalled if the pictures were bad and I shouldn’t be alarmed if that were the case. I do not know who actually reads the films. I think it is a specialist technician, but not a doctor.
The receptionist checked to see if I was planning to go away in the next few weeks because the results will come by post in about a fortnight, and they wouldn’t want me to miss such an important letter. I am not sure what would have happened if I had said, yes, I’m planning to be away.
In case you think women are discriminated against I can tell you that my ex husband (who is 60) does not get offered a regular PSA test for prostate cancer and neither of us has ever had a colonoscopy. (Some of you may be applying for visas right now.) Only one of my four children ever saw a paediatrician throughout their childhood — why she was so singled out is probably the topic for another post — and no child in the UK gets a routine check up after the age of five. There was never a doctor, let alone an obstetrician, present at the birth of any of my children. My blood pressure has only been checked twice in the last 7 years and I have never had a cholesterol test.
Our system in England is certainly fairer. No family goes bankrupt because of a sick child they are desperately trying to save. If my mammogram shows I have cancer I will be treated without worrying about paying for that treatment. It is true that I will have almost no choice about who treats me, nor will I necessarily have access to drugs that are routinely prescribed in the US or even in continental Europe, but I will get what care works for most people and is statistically most effective.
No one in this country has to fight cancer, or any other disease, and the insurance company at the same time, the way Obama’s mother did. If you are not a typical case, though, like anywhere else in the world you might have to fight bureaucracy.
It is possible that it is statistically true, as they tell us, that mammograms and cervical smears are really only required once every three years and that PSA tests are pretty unnecessary. The government is beginning to accept that colonoscopies might be a good plan (cancel that visa application) and there has lately been some movement towards more preventative medicine, but none of this is patient led.
My family and I get care that an uninsured family in the US could only dream about.
My family and I get care that an insured family in the US would consider completely unacceptable.
And just so we’re clear, I pay a lot more taxes than you do (if you are an American).
I don’t know the answer. I am guessing that to spread decent care to all, some of you are going to have to accept less than you are used to.
I’m not sure how I feel about this. I see people everyday who are struggling with how they are going to pay for their newly diagnosed medical problem because they are uninsured. And maybe it’s because I am an American and do work in healthcare that I have a problem with the lack of screening in the UK but I really have a problem with it. It would be interesting to see the statistics. Could it be that all of our neurotic screening is doing nothing more than driving us all batty? I’ll have to save that problem for another day though.
Thanks for stopping by my site. I’ve never had any comments on how hard it is to see. I’ve posted a request for additional feedback. It might be your Mac but if not, I will definitely change it. I want it to be reader friendly, obviously. Thanks for your feedback.
Comment by Smart Mouth Broad — October 23, 2008 @ 5:03 pm
Question – what happens if you develop breast, cervical or prostrate cancer in the years between your allotted screening? How would you even know?
I know that you don’t mean it to, but your post is not exactly encouraging those who are against it to embraced the concept of socialized medicine.
Comment by Jan — October 24, 2008 @ 4:14 am
Are you able to get more regular screenings if there is a history of a certain kind of cancer or other disease in your family?
I don’t know what the answer is either, but there has to be some kind of happy medium. I had a routine mammogram when I turned 40, and the mammogram center wants me to do it every year – they send a reminder letter – but I have decided, with my doctor, that since there is no family history of breast cancer I really only need one every other year. I think over-testing and over-medicating does drive the cost of healthcare up, but you are right that I am appalled at the treatment you are getting!
Comment by Liz @ Inventing My Life — October 24, 2008 @ 6:21 am
Duchess, In your photo, you look just the same. Brother Peter gave me your blog address. He was in Maine for four days and we did a lot of hiking the hills in autumnal light. Earlier this year I put up 63 posts on sea-level rise, now I’m on to consciousness at onmymynd.wordpress.com. Blogs are a great invention, even if not always read. They keep you alert to your own experience as it develops, and to your writing style. With no editor looking over your shoulder. This is just my calling card to let you know I stopped by. –SP
Comment by Dr. Zygote — October 24, 2008 @ 11:50 am
Smart Mouth — They tell us here that testing every 3 years is the most cost effective way of doing it for the population as a whole. The few extra cancers they might detect by having the screening yearly doesn’t justify the expense. That’s fine, unless you are one of the few extra not caught.
Jan — If I had to choose I would still opt for our system over yours, because it seems obscene to me that a family could lose their home because someone gets sick. Or maybe a child dies because there is no home to lose. But it is also a simple fact that I do not enjoy the same kind of care most middle class, employed Americans have access to. I think there must be some answer in between. Medicare strikes me as pretty good — much better than what seniors get in the UK. I am just saying that it is possible to invent a system like this that costs a lot of money and doesn’t quite deliver what we need but mostly keeps people from dying on the street because they don’t have the money to get better.
I am hoping that you guys will invent a better system once you finally decide you have to. Americans are good at inventing.
I had dinner with a friend tonight who laughed when I told him the topic of my recent blog and said that the National Health Service is one of the last great Stalinist institutions. It is like a great train delivering a load of shoes. Every one is a size 8 and they are all for the left foot.
He’s exaggerating, but there is an element of truth.
Liz — I think the answer to your question is probably yes, but it depends a little on your GP. who is the gatekeeper. If you have a strong history of breast cancer in your family you will probably get referred for a mammogram early if you ask and keep asking. Similarly if you have close relatives who have died of a heart disease under age 50 they also would probably check your cholesterol.
Comment by Duchess — October 24, 2008 @ 2:50 pm
I’m so against socialized medicine. I want the right to choose my GP and get screenings every year if I want. I’m sure there are better ways than what we’ve all got now and hopefully someday we can enjoy those better ways. Thanks for giving us a glimpse of your health care.
Comment by Midlife Slices™ — October 26, 2008 @ 6:24 pm
I think I probably enjoy the best of both worlds, here in Canada. We have universal healthcare, for which those of us who are employed and live in Ontario pay a relatively small health tax (usually covered by employers.) I choose my own GP, I have an annual physical, and since I’m part of a breast-screening program, I get a call every two years to set up a mammogram. Because there has been colon cancer in my family, I also get called every year for an endoscopy (camera down one end) and every five years for a colonoscopy (camera up the other end.) Of course, because it is socialised medicare, it has its bureaucratic constraints but, like your NHS – which I experienced myself when I lived in the UK in the late 60s/early 70s – it means that no child will die without care, and we don’t have to mortgage our futures to get cancer care.
BTW, love the blog, Duchess. Hope you don’t mind if I link to it?
Comment by Tessa — October 27, 2008 @ 5:07 pm
Interesting post. Our family has “great” insurance as insurance goes here. We pay dearly for it, but we can choose our own doctors, go when we want to, have annual check ups including mammograms, prostate, and pap smears. Nonetheless, I have $150,000 of medical bills due to my 5 surgeries from the car accident. I think that’s enough to bury most families. I can’t imagine how much higher the bills would be if I had some prolonged cancer fight.
Comment by Twenty Four At Heart — October 27, 2008 @ 10:04 pm