(mal?)Practice as Research

Let me begin this post by saying that I am reluctant to take anything that might be perceived as a pot shot at the NHS in its current beleaguered state. I'm glad it exists. Despite its shortcomings, it remains one of the chief reasons I cannot imagine returning to the land of my birth. At the same time, it occasionally perplexes me. Today was one of those occasions.

Contrary to the belief, current among Americans, that socialized medicine results in high levels of usage, I avoid going to the doctor as much as possible. There are several reasons for this: the doctor's waiting room is a good place to get sick, mine is normally swarming with babies and children (one of which once locked the door from the inside to prevent anyone - including me - from entering the office), and it's always a bit of a crap shoot with regards to who I'm going to see. UK medical practices are complicated things. Most come with a variety of doctors, though one generally only deduces their areas of specialization on an ad hoc basis. I will resist a comparison with the Prague boutique mini-hospital (located in a historic villa) that provided me with orthopedists, internists and dermatologists to my heart's content, and instead commend myself for having deduced which of my practice's docs knows a bit more about all things muscular-skeletal.

I would have liked to see this doctor for today's complaint - a persistently sore left foot - but that would have involved prebooking and waiting and I was concerned about hurting it further as I'm doing a lot of rehearsing at the moment, so I called, dutifully, at 8.30 (aka the Appointed Hour for same day appointments) and was allocated a 10.30 slot with Dr. B.

I had never heard of Dr. B, but I was pleased not to be assigned to Dr. P., she who had once bizarrely asked me, psychologist-style, how I "understood" my persistent knee pain. Right. Dr. B. called my name at 10.30 on the dot. She appeared to be my age, possibly even a bit younger. She listened to my symptoms, examined my offending limb and then engaged in a behaviour I have only encountered with British doctors: she conducted research. In my presence. It's not the kind of research one encounters at a teaching hospital. This is "hmm, I'm not sure...let me just check"-style research.

Within the context of higher education, I'm a firm believer in practice as research. At the doctor? Not so much. On one hand, I appreciate the humility - Dr. B. wasn't pretending to know what was wrong with me. Doctors can certainly err by over-estimating their knowledge and there was no chance of her doing that. On the other hand, seriously? Surely the definition of expertise is that one carries a great deal of knowledge in his/her brain, at least enough to deal with the relatively quotidienne complaints of the day-t0-day patient. Besides, even if my left foot is particularly perplexing, it's not likely I will benefit from being told a potential diagnosis (prefaced with "this might sound scary") and then assured that I can learn more about my hypothetical malady (which might require surgery) by googling it when I get home!

Luckily, I long ago swore off the practice of googling symptoms (tingly big toe + cancer, anyone?), aided and abetted, I might add, by NHS Direct. The nurses on the 24 hour helpline might be paging maniacally through medical dictionaries, but at least I can't see them do it. And that helps.