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Sunday, October 2, 2022

Dr Xand van Tulleken on the legacy of lockdown: Falling ill made me realise the true wonder of the NHS | Coronavirus

I love the NHS. I know this is a fashionable thing to say, but it also has a whiff of naivety. It is like saying I love autumn, or chocolate. Sure, those things are great, but they are also big things that are complex and loving them unconditionally seems to avoid important criticisms (the waiting lists for essential surgeries, the leaves on the train tracks and taking your dog to the vet every Easter, respectively).

I mean, of course, that I love the idea of a nationalised health service, rather than the dysfunctional, underfunded service we have, where staff are even more overworked and underpaid now than they were when I left more than a decade ago. I love the idea of a system in which our freedoms in a pandemic aren’t contingent on avoiding it becoming overwhelmed – despite it coming close to being overwhelmed in a normal year (and, as I write, Covid cases and hospital admissions are once again rising). But I didn’t truly grasp the big idea – that health care has to be free at the point of access – until I got ill.

Only a few careers offer the chance to switch roles and find out what it is like on the other side of a metaphorical desk. Some students end up becoming teachers, some unfortunate barristers end up as “the accused”, and many doctors are eventually horrified, as I was in March 2020, to find themselves in a backless gown, on a gurney in A&E, being asked: “What seems to be the trouble?”

In my case, I knew exactly what the trouble was. I was recovering from a Covid infection and had woken at three in the morning with my heart beating way too fast and in a chaotic rhythm that caused an unpleasant sensation akin to a misfiring engine in my chest. I felt bad: faint, sweaty, breathless, panicky. I knew, from taking my pulse, that I had a problem called atrial fibrillation – and although it wasn’t life-threatening, it did need to be fixed. So, pausing only to congratulate myself on my diagnostic skills, I called a taxi to A&E.

‘I knew exactly what the trouble was’ … Van Tulleken in hospital.
‘I knew exactly what the trouble was’ … Van Tulleken in hospital. Photograph: Little Gem/BBC

From the moment I arrived, the vast machinery of the NHS swung into action, although I didn’t realise it at the time. Since then, I have been into hospital dozens of times and had countless video consultations, scans and other investigations. All of this led to me having an ablation: a procedure that froze away the bit of my heart that Covid seemed to have damaged. This appears, for the moment, to have cured me. But when I sat down in the triage room and the nurse began covering me with stickers and electrodes to get a recording of my heart, all I felt was relief that someone was now looking after me. All I had had to do was turn up and say I didn’t feel well.

Healthcare has to be as frictionless as possible. As soon as people have to fill out forms, call an insurance company or produce a credit card, they stop coming. It is inconvenient enough being ill without having to do extra, expensive admin. I was a pretty dismal patient: I didn’t want to take pills, I didn’t want my operation and I complained every time they shaved my chest to stick on the electrodes. My treatment required extraordinary, underpaid people to care more than I did about what happened next. All I did was open the letters from the hospital, read them and turn up. In the US, the admin for a health problem like mine would have been a part-time job.

But my doctors and nurses weren’t getting paid for each procedure or each test, so there were no financial incentives distorting the decisions. They just wanted to find out what was wrong with me, fix me and get me out of the building. I trusted everyone and everyone who looked after me went above and beyond the simple requirements of the job.

Three people stood out. First, Dr Phil Gothard, an old friend who happened to see me in an A&E follow-up clinic. At the end of the consultation, he said: “You mustn’t let being ill make you think differently about yourself. You’re still the same person, just one bit of you isn’t working very well.” If I ever start seeing patients again, I will say that to all of them. Second was Prof Toby Hillman, a respiratory consultant at University College hospital. Faced with a new disease, he and his team had to figure out how to study it while they were treating it in the middle of the pandemic. Unbelievable. Finally, Dr Oliver Segal, who was eventually proved right about me needing an operation – and was gracious enough not to rub it in my face.

Anyone who says the NHS needs to be improved is right. There are huge deficiencies in its abilities to meet people’s needs and, in many ways, I was very lucky. But, in the past two years, I have learned that the core of its design is extraordinary. The nationalised system means that it relies on salaried professionals who are incentivised by the rewards of patient care. I wouldn’t want to be ill in any healthcare system that didn’t offer that.

Xand van Tulleken is a doctor and the presenter of TV shows including How to Lose Weight Well

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