Anorexia Nervosa: The NHS & Safety Net.

In The Cockroach Catcher, in the opening chapter I recalled an Anorexia Nervosa patient that has been “dumped” by her Private Health Insurer.

Girl in a Chemise circa 1905 Pablo Picasso (1881-1973)
Tate Collection

This patient’s father works for a medical supplies company that continued to insure the family. Even then the Health Insurer chose to limit her treatment to 18 months.

Why? Because there is a safety net: The NHS.

Health Insurers write their own rules.

Why? Because there is a safety net: The NHS

“….Ethics in medicine has of course changed because money is now involved and big money too. What was in dispute in this case was that the private health insurance that sustained Candy through the last eighteen months had dried out. The private hospital then tried to get the NHS to continue to pay for the service on the ground that Candy’s life would otherwise be in danger. The cost was around seven hundred pounds a night….’

Let us not forget that many private hospitals can make more money from the NHS because the NHS does not exclude. The NHS pay for everything including those Private Health Insurers chose to exclude.

“……A quick calculation gave me a figure of over a quarter of a million pounds per year at the private hospital.  No wonder they were not happy to have her transferred out.  Before my taking up the post, there were at one time seven patients placed by the Health Authorities at the same private hospital. Not all of them for Anorexia Nervosa, but Anorexia Nervosa required the longest stay and drained the most money from any Health Authority. I have seen private hospitals springing up for the sole purpose of admitting anorectic patients and nobody else. It is a multi-million pound business. Some of these clinics even managed to get into broadsheet Sunday supplements.  I think Anorexia Nervosa Hospitals are fast acquiring the status of private Rehab Centres. Until the government legislates to prevent health insurers from not funding long term psychiatric cases, Health Authorities all over the country will continue to pick up the tabs for such costly treatments……”

I did not agree to that patient staying on at the private hospital paid for by the NHS. That hospital did not like me!!!

The Obama Health reform is dealing a big blow to Health Insurers as by 2014 they will have to take all comers and cannot exclude pre-existing conditions not to say dumping someone like my Anorexia Nervosa patient. Until then, the State or the Federal Government steps in.

Gov. Arnold Schwarzenegger of California, a Republican gave a rousing endorsement of President Obama’s health plan.  New York Times reported today.

The new government in a week’s time should take the first step in legislating against Health Insurers “dumping” patients because of psychiatric diagnosis or so called chronic conditions. That way, private hospitals and insurers can fight it out amongst themselves. At least  the small pot of NHS cash would be safe. That would be a first step.

I doubt if any government would follow Obama’s extremely courageous move of legislating against excluding pre-existing conditions but we could watch what happens in a few year’s time. If we can at least secure the position of those already insured we could save the NHS a great deal of money.

Unlike the US we have a safety net: the NHS.

Let us protect it. 

How? 

Save the NHS: Control Health Insurers! 

Summary of a popular post:

• Ends discrimination against people with pre-existing conditions.
• Limits premium spread to normal, high risk and healthy risk to say under 20% either way of normal.
• Limits premium discrimination based on gender and age.
• Prevents insurance companies from dropping coverage when people are sick and need it most.
• Caps out-of-pocket expenses so people don’t go broke when they get sick.
• Eliminates extra charges for preventive care.
• Contribute to an ABTA style cover.

                     

We could legislate that Insurers will have to pay for any NHS treatment for those covered by them. It will stop Insurers “gaming” NHS hospitals. This will prevent them saving on costly dialysis and Intensive Care. Legislate for full disclosure of Insured status.

Insurers cannot drop coverage or treatment after a set period and even if they do they will still be charged if the patient is transferred to an NHS Hospital.

This will eliminate problems like PIP breast implants.

It will indeed encourage those that could afford it to buy insurance and in any case most firms offer insurance for their employees including the GMC.

To prevent gaming of Insurers by individual patients (I look after their interest too), the medical fee should be paid up front by the patient and then deduction taken from premiums. Corporate clients like those with the GMC should not be gaming Insurers.

Imagine the situation where those with “individual personalised budget” being able to “buy” their own insurance!

In fact, to save money, government can buy insurance for the mental patients and the chronically ill.

This way their will be real choice and insurers will be competing with each other to provide the worst deal.

Why?

What Health Insurer will want the business? 

Perhaps they will go back to the US and we will have our own NHS back.

The Times:  The internal market has been a costly disaster

Obama Health: Health Insurance Reform

Obama Health Reform: Lessons For The NHS.

Obama Health & The NHS: Patients Trading

An Entrepreneur!

A Brief History of Time: Anorexia Nervosa

The Cockroach Catcher: full review on Amazon, Reader’s views.

Anorexia Nervosa: Let Her Die!

A reprint:

©Am Ang Zhang 2014

Can a patient be allowed to die? 

Can a seventeen year old patient be allowed to die?

Can a seventeen year old Anorexia Nervosa patient be allowed to die?

Are we not supposed to save lives?

Could doctors be held to ransom? By?

Here is a Play: Let Her Die!

The Players:

The parents:

Father used to run a business security agency specialising in industrial counter espionage. Or was it espionage? I cannot be sure.

Too often there is this bizarre desire by some parents to make sure that if they cannot do it, no one else should either. We need to recognise it early enough. We are doomed otherwise, and so is the patient.

The patient: Nicola

It was really quite painful to sit there and talk to someone who looked worse than the worst they showed from Auswitz. Why could Nicola not realise that if she wanted any man to like her she would need to look a lot better, which involved doubling her weight for starters.

The Doctors:

Dr Hillman:

This was a family given up even by Dr Hillman, my most fervent supporter of family therapy. Father used to run a business security agency specialising in industrial counter espionage. Or was it espionage? I cannot be sure.

The Consultant:

        I did not go round looking like a hippie or pretending that I liked the music the teenagers listened to. I told them to me it was trash. I did not pierce my ear or have a tattoo. I certainly did not wear trainers to work.

       

        In short, you do not have to gain respect by becoming like them or worse, by pretending that you are like them.

The Experts:

Salvador Minuchin & Jay Haley

I spent one session with them and agreed with Dr Hillman. They were good. We looked like a bunch of amateurs dealing with professionals. None of the family therapy tricks work, Minuchin or Haley.

        Impenetrable!

The NHS Trust & GMC

To me, suspension on full pay is a risk every doctor takes nowadays, as the basis is no longer limited to bad practice. It is no longer a reflection on whether you are good or bad clinically. Many psychiatrists are no longer prepared to use techniques that might upset their patients or parents of their patients.

The Main Action:

A family meeting was called and it lasted only a few minutes.

          I was in top form.

          “Nicola has been eating but after two months has not put on any weight. I cannot see any reason for her to continue to stay here. She might as well do the eating at home. She can then sort out for herself why she is not gaining weight without the pressure from us.”

          I tried to put it in the calmest way possible.

          “You mean you will let her die?” Father sounded a bit annoyed.

        With that father got up and left the room without saying another word.

          “What do I do now? You have upset him!” said mother.

          Good, something got to him at last, but I did not say it.

         

Nicola gave a wry smile to me as if to say, “You found me out.”

          She turned to mum, “Let’s pack and leave this dump.”

          We all kept still.

         

Six months later, one of the nurses bumped into Nicola in a nearby town. She was kicked out by father and moved in with another ex-anorectic. She was with a boy friend. More importantly she was wearing a very sexy dress to show off her then very good figure.

          She did not die.

                                           Based on an extract from my book The Cockroach Catcher

A Brief History of Time: Anorexia Nervosa

Review on Amazon

Readers' views.

The Cockroach Catcher on Amazon Kindle UK, Amazon Kindle US

2 comments:

Dr No said...

CC - Dr No rather suspected that if you didn't turn up and comment on badmed, then you were probably doing a post of your own!

Dr No reads the moral of your post as less is more, ie the more doctors try to control patients (admission, section, forced feeding), the more the patient resists. Do the opposite (patient can go home, even die if the want to) and the patient still resists - in Nicola's case by gaining weight...even if she did do so rather rapidly...and, of course, having a spook for a dad is enough to put anyone on edge...

E's case (the one recently in the news) is very different. She was almost twice N's age, very different family by the sound of things, significant co-morbdities and a long history of failed forced feeding attempts (albeit with one early success). She was, if such a concept is meaningful, in end-stage anorexia nervosa.

Can a patient be allowed to die? Yes - we do it all the time.

Can a seventeen year old patient be allowed to die? Yes - we reluctantly and with great sadness do it from time to time.

Can a seventeen year old Anorexia Nervosa patient be allowed to die? Not if we can possibly help it. But anorexia nervosa is truly pernicious illness, and sometimes it defeats us all - although usually a bit later in the patient's life.

Would Dr No have discharged Nicola as you did? Almost certainly, and probably for the same reasons! 

June 19, 2012 4:25 AM

Cockroach Catcher said...

It is perhaps The Cockroach Catcher's own experience with young Anorexia Nervosa Patients that has coloured his views. There is in him a genuine feeling that doctors should be allowed to doctor pure and simple and in that sense he feels that psychiatrists should be doctors too, real doctors.

Remember the early days of treating phobia when bus loads of phobic patient from none other than the Maudsley were taken to Piccadilly Circus and dumped there. It was known as implosion therapy. then later suicidal patients were given the sharpest razor blades so that they can get on with it.

In Psychiatry, the best treatment is without doubt Placebos. But placebos only works if neither the patient nor the parents knew.

In reading DN's blog I reposted my patient where I let her die.

Well, did I or was that part of Haley/Minuchin treatment? You can decide.

No the early day psychiatrists did not mean harm to come to the Picadilly or Razor patients, but when non-doctors are involved, good luck to the said patients.

Perhaps DN;s patients was of Millennium Trilogy quality and ooops, what was the state doing?

Please let the real doctors or better still the real psychiatrist get on with their real work, if only they are allowed to remember how to give all the guidelines floating around.

The Cockroach Catcher retired partly because he sensed he would not be allowed to carry on his own doctoring ways. 

June 19, 2012 5:29 PM

Anorexia Nervosa: Cello & Bach!!!

Cape Floristic Region (CFR) of South Africa

 ©Am Ang Zhang 2005

South Africa reminds me of my Anorexia Nervosa patient.

In The Cockroach Catcher I got my Anorectic patient to play the cello that was banned by the “weight gain contract”:

 

                 Jane got on well with me.

          She had to, as nobody understood that to her achieving was not a hardship but something she secretly enjoyed. She was no longer allowed to pick up her books as she had not put on any weight since her admission.

         

          Cello would be banned too, if her nurse was to have her way.

          For the unit to function the nurse must have her way. After all I was not there all the time to watch her. To watch if she was eating, vomiting, exercising or whatever else they did to avoid gaining weight.

          But I was determined that it would be the first privilege she would get if she put on half a gram.  Or any excuse I could think of.

          Brutal confrontation is often what happened in many adolescent units dealing with Anorexia Nervosa. The brutality is not physical.

          But these patients are intelligent and have such strong will power that confrontation generally fails and the failure can be a miserable one.  Yet it is the kind of condition that hurts. It hurts those trying to help. It hurts because these patients deserve better for themselves. It hurts because they are not drop-outs of society. 

          Was it too hard for Jane to keep at the top academically? Someone offered that as an explanation. Perhaps she should be moved to a state school.

          The idea horrified me.

          A fourteen year old non-smoking, non-drinking, non-drug taking, intelligent Audrey Hepburn look alike virgin turning up at your local comprehensive.  It sounded like a major disaster to me.

          I had to take the matter into my own hands. She did put on some weight and at the earliest opportunity I decided she should get back to the cello which had always been by her bed at the unit.

          She missed the cello, the only thing she could use to shut out her worries.

 

          Fourteen and carrying the burden of the world.

 

          Then she started playing.

 

          “Ah. The Bach G-major!”

 

          “So you know it.”

 

           Of course I do. The hours I spent listening to Yo Yo Ma and it was such amazing music, melancholic and uplifting at the same time.

          For a moment I forgot that I was her psychiatrist and she forgot she was my patient.

 

          “My grandma gave me Casals.”

 

          I knew Casals was even more emotional than Ma, but Ma is Chinese and he was less affecting, allowing the listener to tune in to his own mood.

 

She played from memory. What talent! What went wrong?”

 

          “I wish my dad could hear me.”

          It was the first time she could talk about her father. They had a very comfortable life in South Africa when father was alive. It was very difficult to imagine what he would have looked like. It was never clear what he did but he was involved in a number of ventures. The plantation Jane’s grandfather ran was sold when apartheid came to an end. He was involved in some private reserve and he was a photographer of sorts but my junior told me that mum started to cry when she talked about him so she did not pursue too deeply.

Read more:

NHS: The Way We Were! Free!
FREE eBook: Just drop me a line with your email.

Email: cockroachcatcher (at) gmail (dot) com.

A Brief History of Time: Anorexia Nervosa

Lohengrin: Speech Disability, Design & Hypertension 

Bayreuth: The Ruling Class & Photography

Sadness & Songs: Superstition & Mahler

Bach - Cello Suites:  Yo Yo Ma

Altruism & Calamity: Private failure & NHS rescue.

We learn little or nothing from our successes. They mainly confirm our mistakes, while our failures, on the other hand, are priceless experiences in that they not only open up the way to a deeper truth, but force us to change our views and methods. 

C.G. Jung

What is Altruism: 

Man is drowning. A banker watching took out two £50 note and threw it to the drowning man’s wife: “Get him some private swimming lessons!”

There was a public life-guard, he jumped in and pull the man out and saved him.

The wife tried to give him the £100. He refused: “All part of the public service.”

NHS Altruism: 

I give you Choice and Personalised Health Budget, what else do you want!

Calamity: remember Southern Cross?

The Life-Guard: Clare Gerada

The best views are free and the best advice is often free.

©Am Ang Zhang 2015

Imagine a society where you take your beloved car to a Private Garage for some repair work and it turns out that the Private Garage did a very bad job and did serious damage to the engine, transmission and other unknown bits. Now imagine that there is a State run National Car Service that will put right everything and at no cost to you and no charge to the Private Garage that did the damage in the first place.

Would it not be wonderful?

In health care, you already have that right now and it is called the National Health Service. It is free even if the damage was done by a private doctor and treatment will be for as long as it takes. The private doctor will not be charged any fee and some even continues to practice here or in other countries.

Soon, such a National Car Health Service may not be there!

The Guardian
David Cameron is to "completely change" public services, bringing in a "presumption" that private companies, voluntary groups or charities are as able to run schools, hospitals and many other council services as the state.

Writing in the Daily Telegraph about the plans…………..the prime minister says he is seeking to end the "state's monopoly" over public services, with only the security forces and judiciary exempt.

It was one of my Coackroach News Catches over the last week-end and it concerns the mother of Rheagan Hendry; wife of former Scotland captain Colin Hendry Denise. She died from a brain infection following a long battle with illness after a liposuction procedure went wrong. Rheagan wrote in:

The Herald Scotland:

In 2002, Denise checked into a private clinic for what should have been a straightforward procedure to remove fat from her stomach. Afterwards she spent six weeks in intensive care (in NHS hospital), the surgeon having repeatedly punctured her bowel.

In the next seven years (again under the NHS) she endured more than 20 operations to repair the damage before succumbing to meningitis in 2009. She was 43.                             

                                                                                                  

Herald Scotland Rheagan Hendry

Read all about it here>>>>

The surgery was performed by Dr Gustaf Aniansson (from Sweden), at the privateBroughton Park Hospital near Preston, Lancashire. Dr Gustaf Aniansson took himself off the GMC register so that he could not be struck off and it was believed he continues to practice in Sweden.

In the new world order of our NHS, private provider (AQP)for commercial reasons need not let the public have access to information about their activities etc, and even the doctors they provide. As they say, be very afraid.

Another case happened a little while back and again it was a private cosmetic operation that went wrong and the NHS tried to look after the patient for over six months.   Read all about it here>>>>

Even as we like our NHS as much as our woods: looks like private providers for public services is in the PM's mind. Sometimes it is public (taxpayer) money for private failures: catastrophic failures when it is someone's life.