/ NHS incompetence towards sports/fitness issues - Part 2 (or 3?)

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OneLifeOneHeart - on 04 Jul 2013
Me:"So, I didn't keep fit regularly in the past because I used to have some back problems. A couple of years ago in my home country I did something that caused some pain, and after a scan of my spine they said I had to fix/readjust my discs by going to physiotherapy. It eased after a few months and I became sedentary for a long time, but recently I started being fit and active again. I started slowly with non-impact sports like climbing, but the pain has returned since I started doing other activities this year like running. It means something must have happened again..."

My GP:"In the UK, we don't scan the spine unless we think there is some damage, e.g. a fracture. You can try doing the physiotherapy exercises by yourself, or go to a gym."

Me:"But how can you confirm that there is no issue?"

My GP:"You wouldn't be here sitting and talking to me if you had back issues. I would see it just by looking at you if you had a problem. Now please I have to see other patients, so this session is over."

...

SERIOUSLY?!

Is that what medical science is about? Or any scientific approach? And 4-5 or more years of medical education?

If I have a history of ANY medical issue and want to confirm they are healed and/or are not relapsing, NHS can't check it? Lack of money? Or lack of brain?

And... since when can I try doing physiotherapy by myself?!

(P.S.: For those readers who are by default inconsiderate towards other people who may happen to face this kind of problems in life - I have a very time-demanding job and if I am on an online forum, especially so rarely and especially at this time of the day, it's only when I think it's serious and I really need someone to listen and/or to exchange ideas)
Luke90 on 04 Jul 2013
In reply to OneLifeOneHeart:

The NHS has to prioritise, of course money comes into it.
RupertD - on 04 Jul 2013
In reply to OneLifeOneHeart:

Lack of money. Most scans are now provided by private companies. A certain number of scans are contracted for. These must be rationed.
monkeymark - on 04 Jul 2013
In reply to OneLifeOneHeart:

Search online and book a session with a sports physio. Sure it won't be free but if they think any thing is wrong they will refer you to someone who can help.

Either that or get a second opinion from another doctor.

Mark
Carolyn - on 04 Jul 2013
In reply to OneLifeOneHeart:

I'm sure cost comes into it - but equally, surely the scan last time showed there was nothing terribly significant wrong, so what's the benefit in repeating it? Were the physio exercises directly informed by the results of the scan?
OneLifeOneHeart - on 04 Jul 2013
In reply to Carolyn:
The last scan was around 6-7 years ago, a result of sports injury. Yes, I had to go to physiotherapy immediately after the scan (slipping discs and stuff), and they were not "exercises" I could do on my own as in a gym. The therapist had to hold me, pull by back around and stuff like that.
OneLifeOneHeart - on 04 Jul 2013
In reply to Carolyn:
The benefit? Well, I would liketo assume that an NHS also promotes prevention and/or damage control.

A small damage can grow into something big if untreated.
Carolyn - on 04 Jul 2013
In reply to OneLifeOneHeart:

OK, so sounds like you need to find a good physio. They may or may not think a scan will help them work out what's wrong (in my experience it'd be fairly unusual to need one), but if they do think it's necessary, presumably they'll be able to arrange it.

Did you find yourself a decent personal trainer who could get you back into exercise in a structured way to reduce your chances of injury?
Caralynh - on 04 Jul 2013
In reply to OneLifeOneHeart:

I have back issues, in fact currently off work with disc prolapse (again..)
Anyway, last time I had this, I was also keen to have a scan or sthg, but my cousin, who is a sports physio, explained that scans for suchlike are very uncommon. Basically, all they would show would be bulging discs, yet most people over the age of 25 have bulging discs, it's just they don't generally cause problems. The fact you are in pain from it shows all that is needed. Docs generally just say rest and take painkillers. If you want more than that, then you need to get yourself to a physio. Either pay privately, or ask for a referral and wait.
The Lemming - on 04 Jul 2013
In reply to Caralynh:
> (In reply to OneLifeOneHeart)
>
> I have back issues, in fact currently off work with disc prolapse (again..)
>

I'm sorry to hear that. I too am still off work with the prolapsed disks in my neck. At this very moment, I have a bag of frozen peas resting on my right biceps. Its a never ending puzzle to get fit.

As for the OP, you have two options one of which involves lots of money to pay people to fix you or you submit yourself to the mercy of the NHS.

Both Caralynh and myself have physically demanding jobs and come under the umberella of the NHS. We too are at the mercy of the NHS which must prioratise. If you are able to walk and breath then you are way down the list of priorities that the NHS has to deal with.

If you can afford a physio then do so, as you will be treated quicker and may recover quicker.
puppythedog on 04 Jul 2013
In reply to OneLifeOneHeart: Is this still going on, the last two times you have posted it was explained clearly that the nHS provides free necessary treatment. You can access a physio you should do so.
From your descriptions a Scan would be a collossal waste of money. You seek the advice of medical professionals and then do not like it if it does not pander to your hypochondriacal norms.
gethin_allen on 04 Jul 2013
In reply to OneLifeOneHeart:
having such a time demanding job and obviously knowing more than the doctor who's been trained in such matters I'm surprised you bothered going to see him/her.
a lakeland climber on 04 Jul 2013
In reply to OneLifeOneHeart:

The NHS isn't a turn up and cure all ills system where you can demand the treatment you think you need.

When you went to a physio, she/he will have done some manipulation and then given you exercises to continue doing by yourself. It is these that your GP is referring to. In your case I'd find a physiotherapist (private preferably as they have more time than the physios working under the NHS system) who will advise if you need a scan/x-ray for any underlying skeletal problems.

This is what happened with me, I'd been having physio for a while, she sent a letter to my GP who then arranged for an x-ray. Having the request come from a fellow medial professional carries a bit more weight than a patient presenting themselves and demanding expensive treatment.

Learn to play the system.

ALC
EeeByGum - on 04 Jul 2013
In reply to OneLifeOneHeart: Where is your home country? Could you be fixed up there?
AlisonSmiles - on 04 Jul 2013
In reply to OneLifeOneHeart:

The way I see the NHS is that its purpose is to make you functional, not to make you perfect. If you want anything over and above functional, then it's down to you. I tend to pay for physio / counselling / stuff like that to get where I want to be. I don't even see the GP before booking in to physio if it seems obvious to me that physio is what's indicated.
Blue Straggler - on 04 Jul 2013
In reply to OneLifeOneHeart:

You are angry that the GP did not fix you up there and then in a single session, with some sort of medicinal magic wand.

I broke my ankle in 2005. The NHS scanned it, decided it did not need an operation, put a plaster cast on it and loaned me some crutches and when the time came, they removed the plaster and provided enough physio sessions that I could WALK reasonably normally.
They did not turn me into a super-athlete.
The ankle was not perfect.
Some time later, OFF MY OWN INITIATIVE, I visited a private sports physiotherapist who iirc provided a free first consultation (or maybe it was cut-price, 10 or 20 maybe? I can't remember). I then decided to pay for a series of sessions during which the physiotherapist monitored progress and gave me more intense and complex exercises to practice at home. I think I had 8 sessions and paid 200 for the lot, and there were massive improvements.

That is how the system works and I am pretty happy with it.
Perhaps I could have skipped the private physio and looked up "ankle exercises" on the Internet.
What I never did, was whinge on an Internet forum about how my GP was rubbish.
Neil Williams - on 04 Jul 2013
In reply to OneLifeOneHeart:

"I started slowly with non-impact sports like climbing"

Climbing is pretty hard on the body, really, particularly when you get to the point that your muscles are strong enough to cause an injury on their own just by pulling on something the wrong way (wasn't the case for me before I climbed). Though I do wish GPs wouldn't contribute to the fitness issue by just saying things like "if climbing hurts, don't climb", they should perhaps be being more positive and suggesting a different sport for a bit, perhaps one like swimming that genuinely is quite low-impact.

Neil
Neil Williams - on 04 Jul 2013
In reply to OneLifeOneHeart:

"And... since when can I try doing physiotherapy by myself?!"

Since ever. Get a book on the appropriate exercises for your injury and try them!

Neil
Neil Williams - on 04 Jul 2013
In reply to OneLifeOneHeart:

That sounds more like what I'd call chiropractic rather than physiotherapy (though I suppose it's a branch of the latter). The NHS doesn't really do it (it might even question whether it's right or not), but it's widely available privately. Most things the NHS calls physiotherapy can be done on your own using body weight.

As for the NHS doing preventative stuff, largely it doesn't, it's more of a "fix it if it's broken" organisation. Whether that's right or wrong is for debate, but what it does now is probably less costly. I'd be happy to pay more taxes for an improved NHS which would do things like that, but I suspect I'm in the minority.

Neil
Ridge - on 04 Jul 2013
In reply to OneLifeOneHeart:
In addition to the cost, it's worth bearing in mind that something like a CT scan of the spine is probably the equivalent to a hundred or so chest x-rays, (off the top of my head figures). It's only a couple of mSv, (i.e. you've probably doubled your annual radiation dose having it done), and there are probably insignificant health effects, but it's not something to be done if there's no medical need.

However, your GP should be able to refer you to a physio under the NHS choose and book system. However you will not get a specialist sports physio programme on the NHS. That's not what it's there for.
ads.ukclimbing.com
Tony Simpson - on 04 Jul 2013
In reply to OneLifeOneHeart:

I heard this load of cra* from my GP when I went to see about a back problem.

2 years down the line and seeing a different GP saying I can nolonger work, I was sent to see a consultant. MRI done (private but under NHS) and within 7 days had the surgeon on the phone to me say he had to see me that day.

The surgeon could not believe I was still walking let alone climbing, swiming etc. Operated within the week.

GP's are not interested in I cant do my past time anymore or my back feels sore but when it comes to work thats when they start to listen.
Scarab9 - on 04 Jul 2013
In reply to OneLifeOneHeart:
>
I started slowly with non-impact sports like climbing, but the pain has returned since I started doing other activities this year like running. It means something must have happened again..."
>


So you can go about normal life and even climb, but now you want to run and are annoyed the doctor won't waste time with you? As a runner I know plenty of people that
1/ have had to give up because of the damage it can do to your body
2/ lots of people that suffer pain but still run and just try to minimize it
3/ I usually have some sort of niggle of one sort of another
4/ I have to accept the fact that it's quite likely I'll suffer in later years from the damage done from running, if not before hand from a specific injury.

Getting you fit enough to run is not the GP's job. It's a job for a physio or sports therapist and they cost money.
Blue Straggler - on 04 Jul 2013
In reply to OneLifeOneHeart:
> A couple of years ago in my home country I did something that caused some pain

Maybe you should be angry about your home country doing this to you in the first place, rather than being angry at the British NHS for not fixing you up for free
TOS on 04 Jul 2013 - 10.22.217.44 [dab-crx1-h-4-6.dab.02.net]
Dauphin - on 04 Jul 2013
In reply to OneLifeOneHeart:

London? And you can't get fixed? No shit.

http://www.iseh.co.uk/welcometoISEH

You'll be pleased to know it's wallet time.

I agree the NHS is a largely a shambles when it comes to sports injuries. Stop bleating on here and get something done. I guessing from all the advise you've had already on here your not going to take it.

Good luck.

D
Ander on 04 Jul 2013
In reply to Luke90:
> (In reply to OneLifeOneHeart)
>
> The NHS has to prioritise, of course money comes into it.

Absolutely.
Ava Adore - on 04 Jul 2013
In reply to OneLifeOneHeart:

Ask your GP whether he will refer you to a Sports Medicine Specialist. Assuming your local hospital has one.
deepsoup - on 04 Jul 2013
Troy Tempest - on 04 Jul 2013
In reply to Blue Straggler: Man I wish I could get away with saying this to patients.
ceri - on 04 Jul 2013
In reply to Scarab9:

> So you can go about normal life and even climb, but now you want to run and are annoyed the doctor won't waste time with you? ....
> Getting you fit enough to run is not the GP's job. It's a job for a physio or sports therapist and they cost money.

I disagree. It's not about being fit to run, fitness you can improve on your own. Broken-ness can only be improved by medical treatment.
A youngish person should be able to run without being in pain. This benefits the NHS in the long run because they are fit and active and less likely to get heart disease, diabetes, osteoporosis etc in later life.
I spent a year going back and forth form the GP to the community physio with a dodgy knee before I finally quoted the NHS right to choise of treatment and got sent for a MRI scan. I had a torn meniscus which the consultant said would never heal on its own. A year wasted messing about before surgery which should allow me to continue my active lifestyle for at least another 30 years.
I have no idea whether the OP has a condition which can be treated by medical intervention, or his history, having not read the previous threads, but I do think that too many GPs think "you can walk, what are you complaining about?"

Ridge - on 04 Jul 2013
In reply to ceri:
> (In reply to Scarab9)
>
> [...]
>
> I disagree. It's not about being fit to run, fitness you can improve on your own. Broken-ness can only be improved by medical treatment.
> A youngish person should be able to run without being in pain. This benefits the NHS in the long run because they are fit and active and less likely to get heart disease, diabetes, osteoporosis etc in later life.

Whilst I can see where you're coming from, being an active person myself, looking at it objectively I can't really agree.

To keep fit and healthy for life you're looking at good diet and low impact exercises such as swimming, or an hours brisk dog walking ever day. Once we start running up and down fells or bouncing off rocks on MTBs, we're probably accelerating wear and tear quite substantially, so we'll become fit old people who won't die readily but will cost a fortune in replacement joints and dementia care.

There's a happy thought.
sleavesley on 04 Jul 2013
In reply to Ridge: He should have an MRI not CT which has no radiation issues.
(CT scan of spine could be up to 3 years backgraound radiation dependent on how much of the spine was looked at.)
That is as long as he hasn't got any of the contraindications for MRI, such as certain implants/pacemaker etc etc.
Also that he can lie still on his back in a bore from 20-30 minutes whilst he has the scans.

All chronic back pain should be refered for MRI where possible as its the gold standard and gives you relevant information such as whether or not there is cord compression, or any involvement of the nerves.
If he had this scan it would give him a diagnosis on which the physio can recommend an appropriate cause of action.

A private MRI in London would be in the range of 200 - 500.
Ridge - on 04 Jul 2013
In reply to sleavesley:
I stand corrected ;-)
sleavesley on 04 Jul 2013
In reply to Ridge: No worries - most people haven't got a clue in the difference between CT and MRI, or of the stochastic effects of having a CT. :-)
Swirly - on 04 Jul 2013
In reply to sleavesley:
> (In reply to Ridge) No worries - most people haven't got a clue in the difference between CT and MRI, or of the stochastic effects of having a CT. :-)


Yet most people say GCSEs are getting easier. AQA GCSE Physics P3.1 medical uses of waves. In fact the QWC question on this summers paper asked for a comparison of x-rays and CT scans.
sleavesley on 04 Jul 2013
In reply to Swirly: that's not a very nice question for a 15/16 year old!
Perhaps the AQA recognise a shortage in medical physicists and they are doing their bit to address the balance?
OneLifeOneHeart - on 04 Jul 2013
Everyone,

1. I will take the advice of most and go to a physio, but why could my GP not refer me?

2. Regarding the NHS role:
- I understand and agree that a basic healthcare system doesn't need to make you Mr. Gorgeous. For that, I am aware, people go to the gym.
- Note, however, that even the NHS suggests to keep fit, do exercises, do sports, etc in order to stay healthy in the long run (check their website/portal!)
- But what if someone DOES get hurt while pursuing such an activity?
Reading from some of the posts above (e.g. regarding the bulging discs), do they ignore the fact that even the smallest injuries can develop into something serious in the long run?

So, if you get hurt in the gym, you don't get fixed anymore? Doesn't that in a way penalize those who try to stay fit?!?
Considering all the attention they give to people who smoke or drink themselves despite knowing the risks????!!!????
Isn't that ironic?

Honestly, if that is truly the logic behind the NHS, I wouldn't mind opting out from paying taxes to them (if there is the possibility to) and/or would do the very best in my power as a citizen to eradicate it.

3. Consider that I climb/boulder at the very lowest grade and have stopped myself if I had pain when pushing myself. But those were temporary pains that went away.
OneLifeOneHeart - on 04 Jul 2013
4. Oh, and don't you read almost everywhere, in sport guides, books, gyms, etc
"If you feel any pain by doing this exercise etc etc please consult your doctor"??

Is "your doctor" not the GP? Or does it imply everyone has a private doctor?
puppythedog on 04 Jul 2013
In reply to OneLifeOneHeart: You consulted your doctor, now you're whinging about what he said. Not for the first time but for the third time and at least the last time you had the same response. You ignored the advice that time it's given again now. Many services require you self refer rather than GP refer. So self refer and then come back here, whinge again when they don't think you should have a scan either and ask you to do exercises in stead.
nw - on 04 Jul 2013
In reply to OneLifeOneHeart:
> Me:"So, I didn't keep fit regularly in the past because I used to have some back problems.

So what you have is an *un*-fitness issue. If you had made and kept yourself fit your back would have sorted itself out. Take responsibility for yourself instead of having unrealistic expectations of an under resourced and overstretched service.
ads.ukclimbing.com
Skol on 04 Jul 2013
In reply to OneLifeOneHeart:
You are an utter disgrace. Take some responsibility for your own healthcare, and stop whinging!
I see people daily with chronic pain and limbs missing that do not complain and just get on with it.
Can't even be bothered to offer you any advice as you do not deserve any.
Ridge - on 04 Jul 2013
In reply to OneLifeOneHeart:

There's no reason why your GP shouldn't refer you to a physio, in my case it was via choose & book

http://www.chooseandbook.nhs.uk/

You may be able to self refer, but you'll havd to find your neasest NHS physio and ask.
ScottD - on 04 Jul 2013
In reply to OneLifeOneHeart: Ive just been told I'm to active to have a new knee, if I lived a sedentary life I could have one, obvious dilemma.
My mum did say all that running will do you no good.
Skol on 04 Jul 2013
In reply to ScottD:
Sorry to hear that.
Unfortunately the strain on the NHS means that most services only offer joints when pain prevents function, such as not being able to self toilet.
With better funding it could allow joint replacements for self inflicted injuries.
Unfortunately for most, this is not the case.
Perhaps a study should be done on cost,related to preventing sedentary lifestyle problems against the future need for joints in those prepared to keep fit?
Skol
Swirly - on 04 Jul 2013
In reply to sleavesley: Perhaps, it's a nice topic to teach and the girls I spoke to after the exam quite liked that question. IMO for my classes it was a better question than some of the other options in P3 like electromagnetism.
deepsoup - on 04 Jul 2013
In reply to Skol:
Doesn't the term "self inflicted injuries" carry a somewhat judgemental connotation? A sport/training injury is hardly self inflicted is it?
Skol on 04 Jul 2013
In reply to deepsoup:
Hi,
I think that what you said is self inflicted.
You do not need to do these activities in order to function.
In that I mean walk to wherever or go about your daily activities as a human being.
Training is optional and carries risks.
Whereas if you got run over going to the shops to buy food and you broke your hip, then you would be priority for a repair.
Skol
leptine on 04 Jul 2013
I agree that its not unreasonable to ask your GP to refer you to physio, or about how to self refer if that's available. However, scanning everyone who sees their GP with back pain is unnecessary. Taking a good history from the patient will indicate if serious pathology is possibly the cause and patients with straightforward mechanical back pain don't need a scan.
Sonya Mc on 04 Jul 2013
In reply to OneLifeOneHeart:

You won't get referred for an MRI unless you have any red flag symptoms related to severe nerve root compression or cord compression, such as

severe pain from sciatic nerve down into toe
muscle weakness/foot drop
saddle parasthesia (pins and needles)
chronic sciatica which does not respond to conservative treatment and interferes with day to day living (and that doesn't include being able to run/climb etc but is more related to being unable to walk, unable to dress, unable to drive, unable to work, unable to sit etc)

GP's are now able to refer for MRI of the lumbar spine but not for simple back pain which is generally muscular/mechanical in nature (unless there is clinical indication of compression fracture or spondylolisthesis where one vertebrae slips over another.)

GP's cannot refer for cervical spine MRI but they can refer for x-ray to check for signs of wear and tear (though it's pretty much a waste of time and an unneeded dose of radiation as it won't affect management plan).

Your GP's attitude is shocking however and I wouldn't tolerate being spoken to by them in that manner! Get a second opinion and make sure you get a referral for a Physio. They should be able to determine whether there is any risk of nerve involvement. However, unless surgery is an indication there is still no need for an MRI. Scans only tend to be given if there is clinical indication that one is required, resulting in a changing or decision making process of management.

Finally,

I've had surgery on my spine for disc problems
I've got arthritis in my neck which affects my ability to climb and to run
I've got arthritis in my knee which flares up from time to time
Just been diagnosed with arthritis in my foot which can hurt like buggery.

My main piece of advice is see a physio or other therapist that could help, actually follow the advice that they give you. Don't let pain, however chronic rule your life. Bloody well take control, find ways to keep on enjoying being active whether it's by necking painkillers or reducing your pace running, downgrading your climbing etc and simply man the f*ck up.

In reply to OneLifeOneHeart: You seem to be mixing and misunderstanding various things.

Perhaps the GP was a bit rude and abrupt. But let's not confuse what he said with how he said it. Maybe he was correct, but phrased it rudely? The simple fact is that the NHS cannot cater for all aspects of all health issues of all people. It has to prioritise and some areas of health are neglected by the NHS - sports medicine being one of them - and the NHS cannot sort every aspect of someone's health for them as others have very ably pointed out,but there are plenty of other services that can help you even if, heaven forbid, you may have to pay out of your pocket. If you want a do it all health service you will need to pay for it, and yes, that means more tax. Whether that is good or bad, right or wrong, is irrelevant; you need to understand the simple facts of health economics. And you have chucked in the rather teenage "f@@@ the NHS I'll opt out of the NHS" card. Even if that were possible - which it ain't - are you sure you want to do that? If you have a nasty climbing/cycling/skiing accident with broken bones being the best parts, and scrambled mashed up bleeding organs inside, do you really want the NHS to not treat you? You may think this won't happen to you, but it could. Perhaps more likely, you may later in your life have heart disease or lung disease requiring long term NHS care. Perhaps even this seems unlikely to you. So let's go to something very likely to happen to you, cos let's face it, with an ageing population, it will probably come the way of all of us; when you are 86 with pneumonia, unable to cope at home, falling over with brittle bones, profoundly dehydrated with your kidneys failing, needing intravenous fluids and antibiotics and physiotherapy assessment and occupational therapy assessment triggering a package of home help based on your needs, and the doctor says sorry mate, you opted out, we can't help you, perhaps then you may at last see the bigger picture.
Jim Fraser - on 05 Jul 2013
In reply to OneLifeOneHeart:

Doctors do not seem to be very well educated. Their narrow focus on clinical issues seems to prevent them understanding much about the wider world. If they spent as much time trying understand how we ordinary mortals have to get by in this world as they do protecting the "obscene amount of money" they get paid then they might be more effective.

So small minded is the medical profession that sport and fitness pursuits are still seen simply as 'mechanisms of injury'. The huge body of evidence for the need for more exercise seems to have escaped many of them.


PS: "Obscene amount of money" is a quote from a GP talking about her salary at a time before the substantial rises of recent times.
Tall Clare - on 05 Jul 2013
In reply to Jim Fraser:

That's an... interesting take on it, and certainly not my experience. Might I recommend you change doctor?
a lakeland climber on 05 Jul 2013
In reply to Jim Fraser:

Really? Not in my experience though like any group of individuals their abilities and interests vary. Here's one GP who might have a different slant - http://www.ukclimbing.com/images/dbpage.html?id=220229

ALC
confusicating on 05 Jul 2013
In reply to Jim Fraser:

Jings. I shall ask my Rheumatologist about this the next time the encourages me to train for the OMM and gives me drugs to allow me to udge up some routes.

These doctors are, after all, one unit - right?
Pyreneenemec - on 05 Jul 2013
In reply to OneLifeOneHeart:

I'd be really pissed off if my GP had the same attitude ! However, I'm in France and have the freedom to consult any GP I choose. I do have to name my principal GP and pay a penalty if I choose to use another one, but I can change to another with no problems whatsoever.

I've no idea how many patients a typical NHS GP has on his list or if they are genuinely overwhelmed by the quantity of work, but as a minimum, I would expect my GP to take the time to get to know a little about me and orientate me in the right direction when a problem is outside his competence.

I also regularly consult a GP who is a homeopath, when a more natural approach to a health problem is possible. Finding the route of a problem takes time and it is to her credit that a consultation can last 3/4 hour.I've even apologised for taking up so much of her time and keeping other patients waiting.

A further advantage of the French system is that I can directly consult a specialist, it might cost me a little more than if I was referred by my GP, but it can and does reduce waiting times, which has, in many cases been shown to save lives.

The French health system has a huge deficit and new measures are taken on a continual basis to reduce it. The one thing that could and
would bring things to a healthy balance would be to reduce the number of prescriptions. The French consume four times as many pharmaceutical products as most other European countries. To do this, GP's must take the time to thoroughly discuss a patient's problem and not be tempted to take short-cuts and prescribe just to get them out of the surgery quickly.

It very much looks like the UK is heading towards a more American system where those who can pay, will pay a lot more, but will get quality treatment but to the detriment of everyone else.

Jim Fraser - on 05 Jul 2013
In reply to Tall Clare:
> (In reply to Jim Fraser)
>
> That's an... interesting take on it, and certainly not my experience. Might I recommend you change doctor?

What? For a lower paid one? ;-)




In reply to confusicating:
> (In reply to Jim Fraser)
>
> ... ... These doctors are, after all, one unit - right?

No, but there is a pattern of treating injuries during sport and leisure as somehow not part of normal life and as though they are self-inflicted wounds.

An example would be a part of my medical records attributing a neck injury to climbing. Yes, I went climbing that day, but the injury clear occurred during my sleep. The doctor latched onto mention of climbing.

The same thing can happen with injuries during reserve forces service. The NHS thinks they are the MoD's problem and the MoD accepts no such obligation.
Tall Clare - on 05 Jul 2013
In reply to Jim Fraser:
> (In reply to Tall Clare)
> [...]
>

>
> No, but there is a pattern of treating injuries during sport and leisure as somehow not part of normal life and as though they are self-inflicted wounds.
>

There is a pattern *in your experience*. Others haven't experienced the same. I can't quite believe the OP is expecting things that everyone else seems to understand are not available as part of a stretched service.
Jim Fraser - on 05 Jul 2013
In reply to Tall Clare:
> (In reply to Jim Fraser)
> [...]
> ... not available as part of a stretched service.

Only a small minority of the huge numbers of people who present at their GP with back problems will recover completely without intervention. Significant numbers of them will never work again and large numbers of them will have their ability to work or their ability to maintain their fitness changed forever.

We need these people at work earning money and paying taxes and not clogging up GP surgeries for the rest of their lives. That is why ALL back injuries are very important. This is something that easily pays for itself.

Tall Clare - on 05 Jul 2013
In reply to Jim Fraser:

GPs have a very short amount of time to see people. How come everyone else on this thread has figured out that they just sort out going to a physio independently and the OP hasn't?
vark - on 05 Jul 2013
In reply to OneLifeOneHeart:
If you want to know if you need a scan or not read the NICE guideline:
http://www.nice.org.uk/cg88

The point of doing a test is to change your management of a patient. If you know how you are going to manage a patient before doing the test, there is no point doing a test.

Lots of doctors are interested and qualified in sports medicine
www.fsem.co.uk

Little is taught at medical school about it so it is predominantly post graduate training

Unfortunately there are other things that compete for a doctors time. Whilst not important to you they probably to deliver greater benefits to society as a whole. As long as health care is rationed this has to be the way that services are prioritised.

The 45 min GP appointment time described above sounds great but given GPs in the UK run on 7 minute slots this would seriously reduce the availability of primary care.

The big problem we have as a society is that expectations are changing. The perception of the public tends to be that all problems have a medical origin and can all thus be solved by doctors. This is often untrue.

Pay for doctors is probably on a par with many professions given the length of training, responsibility, out of hours working and other unpalatable aspects to the job. If you want to know how much we are paid it can be seen here.
http://www.nhscareers.nhs.uk/explore-by-career/doctors/pay-for-doctors/
GP partners are paid differently and they can earn significantly more but they are self employed and need to cover their own holiday, sickness etc.





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Skol on 05 Jul 2013
In reply to Jim Fraser:
'Only a small minority of the huge numbers of people who present at their GP with back problems will recover completely without intervention. Significant numbers of them will never work again and large numbers of them will have their ability to work or their ability to maintain their fitness changed forever. '

Do you have figures to back this up?
I think that you are missing the point in that there are not the funds for everyone to be seen with every back complaint. The service is too over stretched.
A lot of back pain from my clinical experience, corrects itself with analgesia for the acute event ,and advice booklets for self help to manage the longer term.

tanssop - on 05 Jul 2013
In reply to Jim Fraser:

You really need to get better informed before posting. Your generalisations are utter nonsense. Get a grip
Hannes on 05 Jul 2013
In reply to OneLifeOneHeart: Reading this I'm not sure what you hope a scan will do. What is it that you are hoping it will do? I'm pretty sure it isn't anything realistic.

The MRI won't cure you, it isn't going to change your management (physio and exercise in general is still first line for a slipped disc) so the only thing that will come out of it is that you get a scan report that won't help you and the tax payer will get a bill for a couple of hundred pounds. Now that doesn't strike me as particularly good use of my tax money.

What kind of scan did you have the first time? Was it an MRI or was it a chiropractor who did a plain x-ray?

By all means, when you've gotten yourself a bit more fit and the pain is still there go back to your GP and say it isn't getting better and then you can think about some kind of appropriate treatment. I wouldn't be surprised if the pain is due to those sedentary years
miho on 05 Jul 2013
In reply to OneLifeOneHeart: Well, I don't know what your home country is but attitudes of the healthcare systems and doctors towards prevention and sports injuries seem to vary quite a bit between countries. Just from my luckily rather limited experience the NHS is not the most generous when it comes to treating to non-life-threatening issues. Obviously other people's experiences will be different and things might have changed in the meantime. Probably not for the better. So here is my personal experience:

I have a history of shoulder issues due to not very well-shaped joints. Dislocated a shoulder once on the climbing wall in my home country of Germany. Went to A&E to have it repositioned and then saw a surgeon the next day to assess the damage. Got an MRI the same day and upon hearing how it happend the surgeon gave me a prescrition for 10 45-minute sessions with a physio experienced in sports issues and asked me to come back afterwards. During these sessions the physio worked with me in a gym and also provided massages. I got better but not quite perfect. So the surgeon prescribed another 10 sessions and after that I was probably better than before. All this was on the general NHS-equivalent health insurance. I only paid some small prescription fee.

Later living in the UK I slipped on some stairs and dislocated the same shoulder again. Went to A&E and after some weeks got an appointment with a surgeon. He sent me to a physio who assessed my range of motion and printed off a sheet with some exercises. Saw her twice again where she checked my progress and then declared my to be fine.

I guess this doesn't help you but I can relate to your point very well. My GF had some spinal issues, got nowhere with the NHS GP who offered psychotropic drugs and ended up going to Germany to have herself checked out and paying for a physiotherapist herself in the UK later. It should be said that Germany spends slighty more on healthcare (11.6% of GDP vs. 9.6 in the UK) according to a study in the Guardian.

Mike
jon on 05 Jul 2013
In reply to OneLifeOneHeart:

How's your heart now? I seem to remember you had a problem http://www.ukclimbing.com/forums/t.php?t=540150&v=1#x7245104
damowilk on 05 Jul 2013
In reply to OneLifeOneHeart
I'll just add that not only can an inappropriate MRI not help in back pain, but it can actually be harmful: many will show minor irregularities, nothing to do with the symptoms, which the person then fixates on to the detriment of their recovery.
The only reason to do an investigation is if its going to alter management, not for patient desire. Even though some GPs can access MRI ( through private companies charging the NHS, another kettle of fish), I think the only good reason for a back MRI is for potential pre-surgery planning, and for that reason the request should come from a back specialist who can appropriately decide when it would be useful and interpret the results. And you generally get referred to a specialist if the requisite 6 months of rehab, physio and pain relief haven't settled it, earlier if any red flags as alluded to above.

This time period is partly to ration access to specialists but also because most do get better in this time, and there just isn't anything that different or special that the specialist will do. There are always exceptions of course, and the main thing is careful history taking, exam, and subsequent review to pick up anything suggesting things aren't going the way they should.

Ps this is a general take on things, it on no way should be taken as specific medical advise via an Internet forum to someone I've never met. I'd also suggest that the description in the OP is likely to be a heavily edited and one-sided narration of events.
TOS on 05 Jul 2013 - 10.36.139.187 [dab-far1-h-1-2.dab.02.net]
In reply to Jim Fraser:
> (In reply to OneLifeOneHeart)
>
> PS: "Obscene amount of money" is a quote from a GP talking about her salary at a time before the substantial rises of recent times.

I think you'll find she was being sarcastic Jim....
Skol on 05 Jul 2013
In reply to miho:
Vorsprung durch technik milo:-)
That is the way forward! Self empowerment with an exercise programme so that you can choose to participate with your own healthcare or not! I am sure that your home country physio massaged your shoulder better and that it had nothing to do with a natural healing response?
Skol
Pyreneenemec - on 05 Jul 2013
In reply to Skol & al :

I apologise to the OP for hijacking his thread, but as I have been an expat for over 30 years, I'm not really up to date with health care in the UK and have a few questions that someone might care to answer.

I am convinced that giving sufficient time to a patient is of the utmost importance, however, it has been stated that on average a GP can give each patient just 7 minutes. Therefore I decide to consult a GP privately. Can anyone tell me how much this is likely to cost and how much time a GP would be prepared to give ?

If, for example, I am not satisfied with my GP and would like to consult a specialist directly ( say a neurologist) is this possible on the NHS or would I have to do it privately ? I can see the possible problems of being considered a queue jumper but if I know my symptoms are relevant ( nerve compression for example) I could save valuable time.

I'm lucky to have work related private health insurance that covers almost 100% of my outgoings, which in the recent past have been considerable due to a number of serious problems. Living in the UK in identical circumstances would appear to be all gloom and doom !
altirando - on 05 Jul 2013
In reply to TOS: ....although there was a former gp on question time tv who commented her salary as a gp was 40,000 higher than her salary as an mp.
miho on 05 Jul 2013
In reply to Skol:
> (In reply to miho)
> Vorsprung durch technik milo:-)
> That is the way forward! Self empowerment with an exercise programme so that you can choose to participate with your own healthcare or not! I am sure that your home country physio massaged your shoulder better and that it had nothing to do with a natural healing response?
> Skol

It really comes down to cultural difference. Even if it is somewhat of a stereotype and not wholly true. Muddling through vs. aiming for perfection. Of course you can get quite far with just muddling through. The bang for the buck/quid might even be better.

And yes, the massages helped me doing the exercises that I didn't manage properly vs. never getting any real feedback on my progress and how much I could load the shoulder. Guess what helped my climbing more...

Mike
Dauphin - on 05 Jul 2013
In reply to altirando:

Salary schmallery. There are salaried G.P.s and G.P.s who pay themselves a salary, plus all the extras.

D

JayPee630 - on 06 Jul 2013
In reply to OneLifeOneHeart:

IS this bloke not a troll...?
Skol on 06 Jul 2013
In reply to miho:
Hi Mike,
Without wishing to be rude I think that you're living in a dreamworld, where every little niggle could be treated to perfection for your satisfaction.
As a professional , I wish this was true too for our job satisfaction .
Unfortunately , some physios are being told ' no hands on treatment at all' and there is evidence to back this up in a lot of circumstances. ( perhaps not yours, impossible to say).
As posters have said, there is scant funding and little physio time for the demand put on us.
So , you have to work to priorities. Getting people to function and back to work.

I think that if you want this level of service here, in the real world, then you need and should indeed have to pay for private physio.( not that these are better but that they don't have the restrictions)
Skol on 06 Jul 2013
In reply to Pyreneenemec:
'If, for example, I am not satisfied with my GP and would like to consult a specialist directly ( say a neurologist) is this possible on the NHS or would I have to do it privately ? I can see the possible problems of being considered a queue jumper but if I know my symptoms are relevant ( nerve compression for example) I could save valuable time.'

As far as I'm aware GP has to ok everything. My wife needed MRI as her GP missed red flags. This cost 400 privately but we had results the same day, and she clinically needed urgent surgery to prevent loss of bladder/bowel/ sexual/ day to day function. This was done on the NHS as a priority because the ortho pod said it was. (She plays no sports).

Unfortunately the world is not ideal, and there are the haves and have nots. I certainly wouldn't be worried about queue jumping if you had grave concerns about your health. It would take a special individual to have a pot of cash and the opportunity to use it rather than wait.
Skol
clochette - on 06 Jul 2013
In reply to OneLifeOneHeart:

Time to own up. Hypochondriac or troll?
Troy Tempest - on 06 Jul 2013
In reply to OneLifeOneHeart:
Many posters are recommending using a private physio service. These guys are excellent, it is well worth paying for their time.

In your case however, OLOH, after reading your post (and your posting history) I would recommend saving your 30 an hour for a while and spending 60 an hour on a good private psychiatrist. I think this will help you more than a physio ever could, even then it's a long shot. Thank F*ck you are not my patient.
The Lemming - on 06 Jul 2013
In reply to Barry Chuckle:
> Thank F*ck you are not my patient.

I used to play badmington with two very well respected psychiatrists and both were as mad as s box of frogs. :-)
leptine on 06 Jul 2013
In reply to Pyreneenemec:
"If, for example, I am not satisfied with my GP and would like to consult a specialist directly ( say a neurologist) is this possible on the NHS or would I have to do it privately ? I can see the possible problems of being considered a queue jumper but if I know my symptoms are relevant ( nerve compression for example) I could save valuable time."

You cannot directly refer yourself to a specialist on the NHS. How exactly would you "know your symptoms are relevant"? Lots of patients think this but are often wrong. Obviously GPs aren't right 100% of the time, but generally speaking GPs will make a better judgement of what requires a specialist referral than patients.
Troy Tempest - on 07 Jul 2013
In reply to The Lemming:
Oh yes of course. Personal experience breeds understanding and all that!
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In reply to Jim Fraser:
> (In reply to OneLifeOneHeart)
>
>Their narrow focus on clinical ............ the "obscene amount of money" they get paid

It is the job of doctors to focus on clinical issues. As for the money, yes, some GPs get paid an obscene amount of money. The majority of doctors earn nothing like what a partner GP gets paid.

Dr.S at work - on 07 Jul 2013
In reply to nickinscottishmountains:
define obscene.
Jim Fraser - on 07 Jul 2013
In reply to TOS:
> (In reply to Jim Fraser)
> [...]
>
> I think you'll find she was being sarcastic Jim....


Bearing in mind her circumstances, household, vacation activity and retirement age, probably not.
TOS on 08 Jul 2013 - 80.229.112.255.plusnet.pte-ag2.dyn.plus.net
In reply to Jim Fraser

The figures vark posted on that link aren't 'obscene', they aren't even 'good' ... given the amount of training time and skill level a doctor has. You could add 50% to those figures and they still won't have reached 'obscene' levels.

If a person wanted to make money, and becoming a doctor was the method for doing so, then yes, they 'wouldn't be that bright', because there are much easier ways to do it.
However, of the doctors I know personally, not one of them is in it for the money.
They got exceptional grades at school, they spent half a decade at medical school, and are now hardworking, dedicated healthcare professionals.

I also noticed that my last GP used to show up at the surgery in a 3year old Honda Civic, in a car park strangely absent of Aston Martins, Porsches and Bentleys.

BTW, do you normally base your 'facts' about entire groups of people after meeting just one of them?
In reply to Dr.S at work: Eh? I'm the one saying they don't get paid obscene amounts of money. Shouldn't you be asking the person who used the word obscene in the first place? I'm a doctor, I earn less than 30k. I know GPs who earn four times that - I consider that obscene for less than five days work a week.
MG - on 08 Jul 2013
In reply to TOS:
> In reply to Jim Fraser
>
> The figures vark posted on that link aren't 'obscene', they aren't even 'good' ... given the amount of training time and skill level a doctor has. You could add 50% to those figures and they still won't have reached 'obscene' levels.
>

Well perhaps not obscene but certainly very good. Typical mid-career earnings from those figures would seem to be around 70k, with 100k+ quite normal. Add on the extras of 20-50% according to the figures and those are pretty exceptional salaries.
TOS on 08 Jul 2013 - wood-group-management.vlan432.asr1.man1.gblx.net
In reply to MG:
> (In reply to TOS)
> [...]
>
> Well perhaps not obscene but certainly very good.

You've sort of got my point (ie. the not 'obscene' part).

I know lots of people who earn 'very good' wages, and none of them go round bragging about it. The only reasons I can think someone would claim to earn 'obscene' amounts would be; 1. They were joking or being sarcastic, 2. They actually did earn an obscene amount of money, or 3. They are stupid and don't undstand what an 'obscene' amount of money is.

If you compare doctors wages (including the top end ones) to other professional jobs, they aren't on mega money.

They might be on mega money compared to a lot of joe public, but then have they gone through the same level of training? In both duration and intellectual effort.

Just out of interest, what type of job do you think should pay a 70k to 100k wage and be a fair one for the role?
MG - on 08 Jul 2013
In reply to TOS:

> Just out of interest, what type of job do you think should pay a 70k to 100k wage and be a fair one for the role?


It doesn't really work like that does it? "Fair" is far too subjective. But if you compare doctors' wages to any of solictors, engineers, MPs, senior army officers and others with similar responsibilities and training, they do pretty well. I don't mind this but I do find complaints and claims they are not well paid irksome.
Jim Fraser - on 08 Jul 2013
In reply to tanssop:
> (In reply to Jim Fraser)
>
> You really need to get better informed before posting. Your generalisations are utter nonsense. Get a grip


Oh yeah, generalisation, sure.

4.9 million working days (1 in 6 sick days) and 5 billion per year reported by the HSE. (Probably not including those no longer employed.)

Reviews of research pointing to lifetime prevalences of between 50% and 70%.

This is a really major issue affecting the quality of peoples lives and the economic health of the country.
Jim Fraser - on 08 Jul 2013
MG - on 08 Jul 2013
In reply to Jim Fraser:

> 4.9 million working days (1 in 6 sick days) and 5 billion per year reported by the HSE. (Probably not including those no longer employed.)

And how many of those are identifiable/treatable problems? I would suspect rather few, in which case a "go away, I can't help" may be a bit blunt as a response from a GP but perhaps honest.
ill_bill - on 08 Jul 2013
In reply to Jim Fraser: That article is about hospital consultants. GPs, who are partners, get their income in a different way. They get a share after all expenses from their business are deducted, e.g staff salaries, utilities, equipment etc. just like any self employed person running a medium size business.
Dr.S at work - on 08 Jul 2013
In reply to nickinscottishmountains:
> (In reply to Dr.S at work) Eh? I'm the one saying they don't get paid obscene amounts of money...............I know GPs who earn four times that - I consider that obscene for less than five days work a week.

Thanks for your definition. So 120,000 is obscene, that's what about 4.5 - 5 times the UK national average wage? - that cannot be really defined as obscene IMHO.

For what it's worth vets who have roughly analogus training, academic qualifications etc AND who are partners in small business's like some GP's might get similar renumeration (at the top end)

The vets income is market driven to a certain extent, but in a far tighter financial world than the NHS appears to be. Which if we are happy to accept a market economy makes GP's salaries seem ok.

My 2p






In reply to Dr.S at work: Hi, sure, it's of course a subjective term. Everyone draws the line in different places, that is natural. What would you say is an obscene income? Note that I didn't say 120K per se is obscene. I would also say it depends on how much people work - obscenity in income is, for me, a balance between what they do, how long they do it, and what it entails. Hence in my book, for less that five not particularly long days at work, 120K is obscene. But that's just where my line is, for others it may be different. Regarding the vet thing, I'm not sure I buy that as a justification of the sort of GP salary I'm talking about as vets offer a competitive service in a commercial market and GPs are not exactly competing with anyone else! I'm also sceptical about the reality/morality of QOF and its impact on GP salaries (I think it's called that - QOF - forgive me if I'm wrong, but you seem to know your ground here so I'm sure you know what I'm referring to!).
blurty - on 08 Jul 2013
In reply to Dr.S at work:

I'm not a vet, but we have one in the family. I'd say they are more highly trained & qualified than doctors. As you say, market forces dictate their earnings/ profit.

I think if there was a proper 'market', then doctors would get paid less than they do now.



Dr.S at work - on 08 Jul 2013
In reply to nickinscottishmountains:

I grant you that GP's are not in a commercial market - but a lot of the stuff they do is analogous to GP vets who are - so I was trying to use that as a yardstick.

As to QOF (had to google, vet not medic) I think any incentivisation scheme is prone to people milking the system, they have to be very carefully set up - My impression from the media is that the BMA did a thorough job on the DoH. Perhaps if they had cut the base salary and put incentives in at the same time?

What's obscene? In the back of my head is an idea that 10 times what an 'ordinary worker' gets is a lot of cash - so using a 40 hour week and minimum wage about 15000 a year so ~150000 or using the national average given earlier then about 270000. I take your point that the maximum figure there is a lot if you are spending your day in the scratcher.


It's harder when someone owns a business - they take risks and pocket any extra cash, even if they re-invest and only take out a set wage they still get richer as the value of the business increases. Hard to manage that.

Dr.S at work - on 08 Jul 2013
In reply to blurty:
> (In reply to Dr.S at work)
>
> I'm not a vet, but we have one in the family. I'd say they are more highly trained & qualified than doctors. As you say, market forces dictate their earnings/ profit.
>
> I think if there was a proper 'market', then doctors would get paid less than they do now.

I am a vet, hold the highest available level of qualification in the EU and work in one of the best centres in the UK.

You are wrong.
In reply to Dr.S at work: Agreed - the GP contract was errrrr..how to phrase this?......"well negotiated" and the DoH chose to accept it, let's put it that way!! I'm not sure the DoH really saw what was going on.
In reply to blurty: Vets by definition need to be generalists = I may be wrong there cos I'm not a vet but it seems to be true. Doctors, apart from GPs, generally become specialists..... and GPs say they specialise in general practice. But that doesn't have a huge bearing either way on how highly trained or qualified they are or are not. They're not hugely comparable. I don't think doctors get paid a huge amount, mainly because there is such a variety of experience and income. Perhaps some doctors are paid too much. But there are thousands of doctors in hospitals paid 22K a year. That isn't a lot of money to pay them
Dr.S at work - on 08 Jul 2013
In reply to nickinscottishmountains:

Wide or deep, it's rare to get both in any clinician.

More vets specialise now, either at a species or speciality level, but most are generalists by any human standard.
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In reply to Dr.S at work: Just to be clear, I'm not arguing with you!

I think the NHS doesn't want (to pay to train) consultants with both breadth and depth. I'm not commenting either way on whether that is good or bad, but I can see why it is the case in an overstretched and under resourced NHS.
Dr.S at work - on 08 Jul 2013
In reply to nickinscottishmountains:
> (In reply to Dr.S at work) Just to be clear, I'm not arguing with you!
>
> I think the NHS doesn't want (to pay to train) consultants with both breadth and depth. I'm not commenting either way on whether that is good or bad, but I can see why it is the case in an overstretched and under resourced NHS.

Yeah I know, just clarifying the point.

I don't think that you can train most vets/doctors* to the level of an NHS consultant in a wide variety of areas - nor perhaps is it all that desirable. I think the real key to 'specialised' health care is the ability to effectively manage a team of specialist to care for a patient - an area human GP's could perhaps develop into more?

* we just don't have the brains or the time, let alone the money.
In reply to Dr.S at work: Don't get me started on teamwork and leadership, or lack of and lack of, in the NHS ;-)
Rob Exile Ward on 08 Jul 2013
In reply to nickinscottishmountains: Just start on leadership... Doesn't that come from the top?
duncan - on 08 Jul 2013
In reply to damowilk:


> I'll just add that not only can an inappropriate MRI not help in back pain, but it can actually be harmful) many will show minor irregularities, nothing to do with the symptoms, which the person then fixates on to the detriment of their recovery.
> The only reason to do an investigation is if its going to alter management, not for patient desire. Even though some GPs can access MRI ( through private companies charging the NHS, another kettle of fish), I think the only good reason for a back MRI is for potential pre-surgery planning, and for that reason the request should come from a back specialist who can appropriately decide when it would be useful and interpret the results. And you generally get referred to a specialist if the requisite 6 months of rehab, physio and pain relief haven't settled it, earlier if any red flags as alluded to above.
>
> This time period is partly to ration access to specialists but also because most do get better in this time, and there just isn't anything that different or special that the specialist will do. There are always exceptions of course, and the main thing is careful history taking, exam, and subsequent review to pick up anything suggesting things aren't going the way they should.
>
> Ps this is a general take on things, it on no way should be taken as specific medical advise via an Internet forum to someone I've never met. I'd also suggest that the description in the OP is likely to be a heavily edited and one-sided narration of events.

Agree with this.



In reply to OneLifeOneHeart:

I very much doubt if you need a scan. Treatment rationing and NHS priorities regarding sporting injuries are beside the point here and not driving this decision. Your GP would be entirely correct not to order a scan even if he had an infinite amount of money to spend.

Watch this and think about it: http://www.youtube.com/watch?v=4b8oB757DKc

The messages apply to most of the health issues you have posted about.

Keep active.
Dr.S at work - on 08 Jul 2013
In reply to duncan:
cool vid.
Irk the Purist - on 09 Jul 2013
In reply to OneLifeOneHeart: keep going back. I had chronic back pain and eventually got set for an xray to rule out arthritic conditions. Turns out I have a compression fracture in my lumbar spine. Now waiting for further scans to check other stuff. The NHS rations treatment by making you ask three times. Only the very persistent get help.

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