Sunday, December 28, 2008

Happy New Angioplasty

Coronary heart disease is nature’s way of telling you to slow down - or so the old joke goes. Thing is, heart trouble is the one thing I never thought I would have. I’ve got low blood pressure, no family history, I don’t smoke and I’m fitter than I was twenty years ago. Even as they wheeled me into the operating theatre I was still insisting they must have made some kind of mistake. Unfortunately, they hadn’t.

Actually, it isn’t an operating theatre and looks more like a cold store, with the medical staff wrapped up against the cold and standing behind screens. Something to do with all the x-ray machines. The procedure is called angioplasty and involves threading a tube through your wrist into your heart to detect blockages in the main arteries of the heart. If they find any, and on me they did, the doctor inflates a tiny balloon to open up the blocked blood vessell. Then they feed in a little latticework tube called a stent to hold the walls of the artery open. This may be more information than you need - but if you are a middle aged Scottish male it’s worth knowing what you’re in for.

If you want, you can watch it all happening on on two large TV screens next to the bed - like some coronary sat-nav. It only takes an hour, and then you’re out of there, but it was one of the most extraordinary experiences of my life. You cannot fully appreciate the wonder of modern medicine until you see your own beating heart being fixed from the inside. Amazing. Sobering too: the fact that this kind of procedure is as routine as plumbing tells you all you need to know about the state of Scottish hearts. They may be brave, but they are also broken.

Coronary heart disease is still Scotland’s number one cause of premature death, killing one in four men - one of the highest rates in the world. And it’s not getting better either: among Scottish men aged 35-54, deaths from coronary heart disease rose from 60 per 100,000 in 2003 to 62 per 100,000 in 2006. We are 60% more likely to die from heart disease than men in the south of England. In 2009, CHD will remain the great medical challenge for the Scottish health system. No one really knows why we are so vulnerable to heart disease and unfortunately, as I discovered, looking after yourself is no guarantee of not getting it.

The doctors shrug and say: “Well, it’s just Scotland”. Yes, we tend to smoke, drink and eat badly, but that’s not the whole story: I don’t even eat most dairy products. Researchers have looked at everything from rainfall to the water supply without finding any obvious environmental factors. Perhaps there is some insidious psychological quality of life in Scotland - the dark, the way people treat each other, the anger that seems to afflict a lot of Scots men. But that doesn’t make a lot of sense either since men in England are pretty emotionally inarticulate too, and the stress of life in congested London, where people often have to commute three hours a day, is surely greater than in Glasgow. Anyway, I spent half my working life in London.

Sometimes there just aren’t simple explanations for things that go wrong with our bodies; there is only the dealing with them. Preventive medicine for all its virtues, can never replace the hard-headed business of fixing the plumbing, doing it early and doing it right. This is what the National Health Service is there for, and does superbly well. I could not fault the care I received from the much-maligned Edinburgh Royal Infirmary. Within three weeks of complaining that I had chest pains I’d been diagnosed, scheduled and dealt with. They were calm, highly efficient and kept me properly informed at every stage in the process.

In fact it was a shock to discover how good the NHS actually is, since I haven’t been in hospital for over thirty years. The wards seemed clean and even the food was pretty good - for mass catering. The equipment is state of the art, the medical staff are mostly brilliant, and they really do try to treat you as an individual. Simple things like asking you what name you would like to be called by. Yes there is bureaucracy, and the nurses seem to spend most of their time shuffling paper. But that’s largely a result of the target and compliance culture that has afflicted the NHS in the last decade. As a patient you have to fill in endless forms and legal disclaimers before they can do anything to you. I mean, you’re hardly going to refuse, are you?

Media coverage of hospitals tends to focus relentlessly on what goes wrong in the NHS - MRSA, chemotherapy cock ups, waiting times, C.difficile, dirty wards - so we get a distorted view of what the service actually delivers. I’ve always been a supporter of the NHS, but even I had begun to accept the conventional wisdom that it is bureaucratic, slow, inefficient, uncaring and that it represents a financial black hole in the public finances. Not true. As I lay in bed playing with the remote control that allows you to configure the bed into an infinite number of positions, I wondered why the public image of the NHS is so unlike the reality.

Partly it’s history: a lot of money has gone into the service recently and there has been a lag in public perception. Those 90’s waiting lists did a lot of damage. But I also think marketing has a lot to do with it, or rather the lack of it. The private sector runs all those BUPA ads showing happy patients being given care by attentive nurses in clean hospitals. The message is that none of this is available on the NHS, whose image is conditioned by press stories about dirty wards and people dying before they get their operations. The debate about private medicine is skewed by this misperception.

Imagine if the NHS could employ Saatchi and Saatchi. The campaign would be simple. Here's one of the best health services in the world, according to the World Health Organisation, which is free at the point of need, is run by dedicated staff who really know what they are doing, and requires no expensive medical insurance. It really is the bargain of a lifetime. Especially for middle aged Scots men. So, use it or lose it. I did - and I know who’s going to have a happy New Year.

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