By chance I saw two patients from other European countries in my surgery this morning. Both of them irritated me, although I tried very hard not to let this show. And because I was aware of my irritation I also tried to be fair to them.
The first was a young man who has booked an arthroscopy for his knee pain, to be carried out by an eminent orthopaedic surgeon in his home country in just two months time. Since he pays taxes and national insurance in this country he would like the NHS to pay for his operation, and he has found out that he needs an E112 form for this to happen. Guess whom he was advised to see about this? You have guessed correctly - his GP.
At first I was affronted - why should this man come to live here and then expect the NHS to pay for an operation back home? But I could also see his point of view that since he was paying his contributions he was entitled to an operation, and why shouldn't he have it done in his preferred European country? Fortunately I had a fair idea of how the system worked and a quick search on Google confirmed that I was right. The NHS will pay for such an operation provided that an NHS consultant has confirmed that the treatment is necessary and that it is not available “without undue delay” in this country. I think that the local waiting list for knee arthroscopy will not be considered as constituting “undue delay” and so the NHS commissioners will turn down my patient's request. I also suspect that he will run out of time before the decision can be made. In either case he will be faced with the choice of a free operation in the UK or paying for it to be done back home. I told him all this and he asked to be referred to an NHS consultant, which I have done.
The second patient was a woman who has had several miscarriages and is now in the early stages of another pregnancy. I have already referred her to our local experts and she is due to see them in a few days time. However she has just been back to her own country to see her own gynaecologist and has brought back a list of treatments that he wants me to prescribe and blood tests that he wants me to order. She wants the results of those tests to be sent to her gynaecologist so he can continue to monitor the situation.
I can foresee problems here with the patient running between two experts in different countries and expecting me to carry out the wishes of the foreign expert if they differ from those of the local expert. That is really an untenable position for me to hold. And although my patient undoubtedly has great faith in her “home” expert I don't know him from Adam. I do not want to act as his proxy in this country. But of course I understand that my patient will treat his word as gospel and may have little faith in “our” expert. I felt I had to take some sort of stand, and fortunately she has a sufficient supply of the treatments recommended by her expert to last until she sees our expert so I declined to prescribe anything until she sees him. As far as the blood tests are concerned, some of them are routine antenatal bloods which will be done in due course and have no bearing on her problem of recurrent miscarriage. The problem with the other tests is that I would not know how to interpret them if I ordered them. It would not be right for me to order blood tests on behalf of her expert and then take his advice, with all the problems of language barrier (he does not write very comprehensible English) and medico-legal problems of responsibility. I also think it will be a bad thing for my patient to be under the care of two experts. I have tried to explain all this to her, but her command of English is not perfect and I don't speak her language at all.
I hope I have not upset her or appeared rigidly unhelpful. She may yet need my help if things go wrong in the pregnancy despite the best efforts of experts in two countries.