Drugs. How do they work?

It is interesting to exchange views about how differnt systems work in different countries.
Can you please explain more about how Austrian health service works, and who pays for it, Petzi?

We could certainly do with some imporvements here, but the previous experiences with the privatisation of services in in the past - like railways - is that things become outrageously expensive but services become much worse.
It took several horrific railway crashes and a big loss of life, before railways came back into the puiblic ownership again to make travelling by train less risky.

I dread to think what would happen with NHS if it was privatised.
Who on earth could afford the horrific medical insurance and charges as well as inflated prices of medicines that are charged in some countries where medicine is treated strickly as a buisness, not as a necessary public service.

There is no ideal system, I agree, but of course anyone here who is not staisfied with NHS can also subscribe to a private insurance, like people must in US for example if they need any medical treatemt but if you cannot afford insurance, you have no other choice. You cannot afford it, bad luck there is nothing else for you.
BTW Pen, I was referring to what you say about not having any migraine pain, after few days in between each bout of migraine.
HerrLady - if you wish to look through the list it is available here, but it is very long:
http://en.wikipedia.org/wiki/List_of_drug-related_deaths

It would be really good to get an excellent, hight quality health service such as you describe in Austria for example, Petzi, if it was provided equally for all people.

It would be even better, if countries would learn from each other' experinces , but this is seldom the case is it?
.

wow, petzi, i wanta move to austria! it sounds up to date and humane. dianne

Doesn't it Dianne......let's go!!!!

I have just returned from my pain management assessment.
Whereas nothing was discussed about "stronger" drugs.
They stressed that most pain patients are under medicating rather than over.

I was advised that I should take what I need, as soon as needed.
That there is no evidence for MOH or rebound in the pain patients they deal with.
And that more is less in the end....

Oh and they have had no notification of any cuts in service for at least the first 6 months of next year..
Good news eh?? Sure we are due some....

pen, we'll go together, but of course i'll have to WALK, since i don't fly, and get seasick. ha! and how about the airport craziness going on here now? i wonder if you have the same nonsense in UK airports? (the pat-downs and x-raying body scans). i admit to not listening much to the news about this. dianne

Pen,

That's good news. At least you can stop worrying about things and take what you need.

Diane,

Why don't you just drive?

Hey Becky.
According to these people who deal just with "pain", that's what we all should be doing, and then it is likely we wouldnt end up at a pain clinic.....

I told her since I take them more when I feel I need them, instead of holding back.....I am not actually taking any more...
She said, that is what they find. Partly because there is less stress involved. Makes sense to me.....

This NHS experience was a good one. Nice people.
Now I wait to see if they want me on the programme.
Either in a group, one to one, or not at all...
Wont know much before the end of the year, and would start January....for 8 weeks.

Pen,

Sounds so obvious doesn't it? If you treated it in the first place, it wouldn't be so bad now. Sort of like an infection, if you treat it sooner, you don't end up in the hospital.

Hope this really helps you.

Thanks Becky.

Yes it does sound obvious.
Sadly two flaws...

One: you have to get a hold of enough of the right medication in the first place...
Two: These sensible people are at the end of the chain, when all else has failed. Not the beginning...

P

Don’t get jealous ladies.

You might think that my fellow country men and woman would be grateful for a great health system. Not really. They like nothing better than to moan and complain about their lot and tend to (at least in my family) prefer the local quack (i.e. homeopath) over their GPs.

Some of the differences I noticed are: You can choose your GP. You are not tied to a GP in your area. If you don't like your doctor you are free to go and see another one. You also don't need a referral to go and see a specialist. If you have a ladies problem you just go to the gynecologist, if you have a skin problem you go to the dermatologist etc. You don't have to go to the GP first in order to then get a referral, but he will refer you to a specialist if he thinks it is necessary. Certain hours of a GP's day are reserved for home visits. I don't know what I would have to do to get an English GP to see me at home. There is just no way I could ever see that happening. I would probably have to drag them out of their homes kicking and screaming.

Last summer my in-laws visited us in Austria and my father in law arrived on a Saturday with a frozen neck. The GP arrived on his bicycle in his rather fetching bicycle shorts, syringe in hand and administered an injection. After the shoulder was sorted out we had a pleasant little chat over a cup of coffee and off he went again on his bicycle.

I also noticed that GP's here seem to have a phobia of actually touching their patients. Whatever happened to a thorough physical examination? It seems to be beneath them.

Austrian doctors practices are much better equipped. Many are equipped to carry out minor surgery, plaster casts (important in alpine areas where there are plenty of broken limbs from skiing accidents), ex-rays, scans etc. The receptionists and nurses are friendly and helpful. Here in the UK after ten years in the same GP practice the receptionist still asks for my name and looks at me as she has never seen me before?!?! And that is when she finally acknowledges me after rummaging around on her desk and studiously ignoring me for an unfeasible amount of time.

The fact that Austrian GP practices and hospitals are so gleaming is down mainly to mentality. Cleaning is a national obsession and this obviously includes their hospitals as well.

All in all contributions to the health system are much higher than here in the UK, but then there is also significantly more money spent on patients (around Euro 200,000.- more per cancer patient compared to the UK).

In general I adore living in the UK. I love the brits for their GSOH, their open mindedness, sense of fun and kindness, but I do wish they would put a little more effort into their health system.

Pen,

Thanks for updating us regarding your visit to the pain clinic. This is exactly my sentiment. I am glad I came to this conclusion years ago. I am by no means over-medicating, but I take what I need to get me through the day without stressing over it.

P.

Thank you for the thorough explanation Petzi.
You are so right about Do Not Touch Phobia here in UK. The doctor in UK will do anything, rather then examine the patient, and even when they do, they are very clumsy and awkward, as if they do not know what they are doing - due to the lack of practice.

I think their pathological fear of touching is caused by the fact that practically the only thing the doctor can be struck off medical register, and loose their right to practice medicine is for sexual misconduct. They can kill countless patients, and are still "covered" by their expert collegues, but touching a patient was and still is a tabu. One thing they fear more then anything.

I also think, that in comparison with the continental Europe, most GPs here are very poor at diagnostics and seldom, if ever, use a simple blood/urine test to establish what is wrong, prefering instead to pump us with pharmaceuticals. If they don't work, they give you another. Such approach leads to lots of s/e, and whole picture gets even more confused. IN the end they might send yout to a consultant/specialist to find out what is wrong..

MY GP told me recently that when I see the new consulatnt, I can choose to go to any hospital I wish, and even book it myself anywhere in the country, according to their waiting list , or general rating.. I have used that system, but in the end asked the receptionist to make the final booking and she did it as I waited and checked with me what I prefered.
I find it all useful, as it gives me some option to avoid places where I do not want to go. Or, if I want to be near my family in different part fo the country, for some procedures.

I am in a large GP practice, and we can choose any doctor we want to see, in fact I hardly ever see my "main" doctor, as I prefer a woman doctor who is only there part time. I can book my appt on the internet as well. However I do not like this big practice, even if they are reasonably well organised and provide such things as Asthma, Diabetes and HB clinics on site, and "cuts and bruises" clinic is also available, with no appt necessary.IT is much less personal.

I do miss your "bicyckle type" personal attitude, which I (almost) had (minus bicyckle) with my previous doctor, but it was a small practice and I think they are probably "modernised" and getting bigger, by now.
I thinkwhat is going to happen in 2011, when GPs get all the funding, is that they will have to watch the money, and this might cloud their clinical judgment about what is in the best interest of each patient, from medical point of view.

Up to now it was not up to them to worry about how much any treatment costs; so, if they send me to a neurosurgon to have my brains rewired (if such things exists to cure migraine, for example) now they will hold finacial strings, and they might think twice about it. I think if GP's will have to fund all medical decisions, medical decisions will be overuled by financia rewardsl, and this is what worries me.

The idea in White Paper is that GP practices will join others in a consortium, which will be responsible for "commissioning" - planning and paying for your NHS services. This will include planned and emergency hospital care, rehabilitation, most community services and mental health and learning disability services.
This is what is happening in effect from the next April.

One more question Petzi - do you also pay something like National Insurance in Austria with your salaries/taxes?
I think people here would not mind to pay a little more in NI, if we did get real improvement in those areas of NHS, which are still lagging behind.

Thanks for all information, Petzi.
I do know about the high standarts in Austria - I have visited quite few times, and have some close Austrian friends as well.

The hospitals here were much, much cleaner in the past when we still had matrons to keep an eye on things, but then matron's were sacked and soon private firms took over the cleaning during the previous conservative governemnt, and it all went down hill from there. Dozens of hosptals were closesd down as well. The whole culture has changed forever.

National insurance contribution in Austria is 7%. This is shared approx. 50/50 between employee (deducted from gross income) and employer.

It never occured to me that this might be the reason for doctors not touching their patients. How very odd!!!

P.

Very odd indeed. Petzi.
It took years, before the penny dropped. It was a friend's husband who is a doctor who made me realise what is going on when during some discussion he said something like: I do not wish to be struck off, so I do not bother with examinations, why take chances.

Very interesting observations about this fear of touching patients to do an exam. In the US I have never observed this problem. However they will always have a nurse in the room during an examination as a precaution against any impropriety (or the perception of one). This is the case for both male and female doctors and is considered good practice. Also they generally would not prescribe anything for a patient they had not examined for fear of a malpractice lawsuit. Not that I think it makes much difference in the case of migraines. They still just seem to try one drug after another until they find something that works.

I do wish we had a better financial system for paying for all this however. Companies cannot afford the huge hikes (double digit every year, about 40% this year) that the insurance companies keep making (with record profits). Our medical costs are the highest in the world, but our medical outcomes are down around 40th. More and more people have no insurance at all or must pay for a large portion of the costs. The new healthcare laws set to take effect in 2014 should help with some of that, but the new Republican congress is vowing to repeal those laws. I worry for what will happen to so many people the insurance companies refuse or who don't have jobs that cover insurance. They continue to get under treated until their problems are so bad the hospitals have to take them. It's no way to run a medical system.

I agree with you totally Migrainegirl. I fear I have a number of things wrong with me that I would like to find out about. And have treated if appropriate. But even with partial payment from insurance at work, it doesn't come close to covering my medical costs. I have the choice of going to the doctor when things are bothering me and living in the street or not going to the doctor and paying for shelter.

Chris

WE use to have the nurse with a male doctor many years ago Migrainegirl, but not any more. Fortunately we do not have quite ass many malpractice suits here, although much more now, then in the past since many law firms began to adevrtiser "no win, no fee" services to people.
I think after this happend lots of money in NHS gets bled paying for malpractice suits, instead of being spent on better service for patients so viscious circle.

I am so sorry for anyone that must live with a worry about the cost of insurance going up by so much -and who can justify such high rises, and why.
What choice people have if they are sick? It breaks my heart to think that people must live in pain and cannot afford treatemnt or medicines in any country on earth, specially in wealthiest ocuntry on earth - it simply does not make any sense.

Our NHS has many faults but no one gets turned away, and you can get excellent teratemnt specially if you are prepared to do your own reserch of what is possible and what is not, and work with it.
I think there is a lots of waste as well, as always in any big organisation, but the very top hospitals and dotors are all runby NHS, so it cannot be bad.

What I don't understand is why there are so many voices speaking about not wanting the new system in your country, surely it is much better to have something, then nothing, when millions and millions of people have no cover of any kind andd no hope of any cover, ever.I am lost wher there is logic in such thinking. I do not know details of course - but my impression is that too many people object on principle, without even giving the new system a chance.

It would be great if we all had acess to the perfect health service, and I do not care how it is called, but in meantime we all need to use what we have and to fight to get better.

Mini,

Michael Moore's documentary "Sicko" explains nicely why many Americans are opposed to an NHS style health service.

Hearing the stories from our American friends makes me appreciate the NHS much more all of a sudden …. even if the English doctors don't really like to touch for fear of being branded a pervert.

P.

Yes that documentary is a good one. It has been a very strange year here. There were very dishonest politicians who get a lot of money from the insurance companies and the doctors saying all kinds of untrue things to scare people. Many elderly people were told there would be "death panels" for example. Or that it was a big government take over of healthcare. When in fact neither was true. And many people still believe this. Of course they are the ones who have some level of insurance or even Medicare (which actually is a government run program). So it's gotten to be pretty sad really. We will have to see whether they really do try to dismantle even the little bit the actually made it into law,

Was your 'list', Mini, in reply to this HellerLady's remark?:

It is quite apparent you do not like those of us in the States (and our health system) but if you are going to cast this negativity at least have your facts correct!

Mini's reply:

HerrLady - if you wish to look through the list it is available here, but it is very long:
http://en.wikipedia.org/wiki/List_of_drug-related_deaths

MINI - and you, have you actually looked at this list, and what does it say ?????

Janet Achurch (17 January 1864 [1] — 11 September 1916) was an English stage actress
Major William Barnsley Allen VC DSO MC and Bar (8 June 1892 – 27 August 1933) was an English recipient of the Victoria Cross
Jean Améry (October 31, 1912 – October 17, 1978), born Hanns Chaim Mayer, was an Austrian-born essayist....
Howard Arkley (1951–1999) was an Australian artist, born in Melbourne,
Karen Lancaume (January 19, 1973 – January 28, 2005) was a French adult film star.
Sidney George Barnes (5 June 1916 – 16 December 1973) was an Australian cricketer and cricket writer
Brendan Francis Behan [....] (9 February 1923 – 20 March 1964) was an Irish poet, short story writer, novelist, and playwright who wrote in both Irish and English.
Richard Burton, CBE (10 November 1925 – 5 August 1984) was a Welsh actor.
Diana Spencer-Churchill (11 July 1909 – 20 October 1963) was the eldest daughter of Sir Winston Churchill and Clementine Churchill, Baroness Spencer-Churchill (née Hozier).
Gertrude Margaret Lowthian Bell CBE (14 July 1868 – 12 July 1926) was an English writer, traveller, political officer, administrator, and archaeologist
George Best (22 May 1946 – 25 November 2005) was a Northern Irish professional football player,
[b]Leah Sarah Betts (1 November 1977[1] – 16 November 1995) was a schoolgirl from Latchingdon in Essex, England.
John Henry Bonham (31 May 1948 – 25 September 1980) was an English drummer and songwriter,
Stephen Maynard Clark (23 April 1960 – 8 January 1991) was an English musician,
Charmian Clift (30 August 1923 – 8 July 1969) was an Australian writer and essayist
Natasha Louise Collins (7 July 1976 – 3 January 2008) was an English actress and model.
Michael Cooper (1941–1973) was a British photographer
Patricia Cutts (20 July 1926 - 6 September 1974)[1] was an English film and television actress.


the list is indeed very long.

on my own I remember the death of
Brian Samuel Epstein (pronounced /ˈɛpstaɪn/) (19 September 1934 – 27 August 1967) was an English music entrepreneur, and the manager of The Beatles,
Dalida (17 January 1933 – 3 May 1987) was an Italian singer and actress, naturalised French,
Jim Morrison of The Doors died in France,


should I go on?

Also, a lot of these deaths are due to other factors besides prescription painkillers - in a fact,
if you look even at glance, most of them occurred due to cocaine, heroine, morphine and alcohol abuse.
Barbiturates are mentioned frequently also, but these happens mostly up to the 80 ties.

Really, there is so many variables here, that summing up your "hardly a week goes by" in one debatable link
is gross exaggeration.

It sure pays to read a bit BEFORE you post a link.

Let's see - hardly a week goes by that we don'tt hear in the newspapers of another famous person's death in US, due to overprescribed drugs (often painkillers), courtesy of their doctor.

Interesting news you have in UK, then. Exactly what kind of news are you reading, then, Chat, Now and OK
or perhaps you like to watch alike TV shows? because we certainly missed that while being right HERE.

Btw I think what you wrote is disgusting and in bad taste, beside being simply untrue.

Many of these tragic deaths where celebrities are involved, aren't as simple as you trying to make it be -
a "bad American doctor overprescribing drugs".
(nor are a UK doctors such an exceptional angels as you always are trying to imply)

Celebrities are humans, too.
They are susceptible to depression, and other psychiatric ailments as anyone of us do. Pain, too.
They also live this life of money, privilege and excess where I imagine more often than not it is quite difficult
to remain simply sane, and moderate.
Their children often grow up without parents, being brought up by nannies and maids and other staff members. No wonder as teens and adults they delve into alcoholism and other addictions.

btw a celebrity if they want to, they certainly doesn't need like us to go to the same, one dr to beg for one measly Rx of, say, Oxy -no they can assume many identities and pay other people to make the deed for them.
They finally can buy it off the street, so it's not necessarily the fault of the doctor, mind you, if some of them abuse Rx painkillers or other meds.

I am not defending the truly bad doctors who do exist, I am just saying take ALL the facts under consideration before you start your swift and easy finger pointing.

Risa

i agree with mini but just want to add clueless that taking too many meds and the fatal affects from it isnt just affecting celebs.

Mini.....
Good post, you and I are on the same page today

Dawn,
You probably missed my post here, it is a way back.
I made it to the pain clinic.
The people there said we are being under-medicated regarding pain.
We need more of the right medication and then we wouldn't end up at a pain clinic.

Also we need the pain clinic at the beginning of the process, not in desperation at the end.

I dont think this means we need harder drugs. Just the right ones and take them appropriately.
This means not having to agonise over not having enough of the appropriate drug (Triptans).

They say they are getting more migraine patients since the MOH thing has been pushed and interestingly
Not one of the team (all medical) had any time for it.

They were much more interested in getting to patients sooner and teaching GPs (they had just had a conference with 50 of them),
to take us seriously and give us the drugs we need in the quantities we need. And NOT scaring us off from taking them.
They are trying to educate them to understand pain and the fringe benefits of NOT treating it soon enough and adequately...

If they did this, people hopefully wouldnt be overdoing OTC like my neighbours sister.
And with the correct drug at a strong enough dose "prescribed" and therefore monitored, we would all be better off.

I liked what I heard. And I learned about half life of drugs and we spoke specifically about my drugs and amounts. (of course).
I now understand that my question about MOH/Rebound and the relevance to half life is an appropriate one.

According to these people, even if I took 18 or more Triptans a month, but in the correct way, and with no "topping up! feeling.
There is no problem. AS LONG AS THEY ARE WORKING.....it is when they are not, but one continues to take them, the problems can arise. Same with the OTC. If taken when needed, and not increasing in "need". No problem.

Now I know thats just another view, but it is a medical one, from a team who deal specifically with pain, at our local hospital.
So as it is first hand from me, I thought it was worth imparting.....


Pen

Good post Pen. What you wrote made a lot of sense to me. I just wish the neuros would get on board (around the world) and not stress their patients out about "is this appropriate to take or is it going to be worse". Just use your head when it comes to medications.

Risa - thanks for the post. I never even saw that link but I figured it was foolishness. I've decided to ignore Mini - she has very little that's positive to add to the community and is not worth the time or effort to respond to.

Migrainegirl - I am one opposed to the new health care bill. Frankly, I think they went about it all wrong and this bill was a giant mistake and I hope it gets repealed. Having said that, I do feel that there needs to be health care reform, but that doesn't equal federal run health care.

I'm probably going to get flambeed for what I'm about to say but health care is not a right, it is a privilege. Do I think those who can't afford to go to the doctor should do without - generally no. I take exception to those who refuse to work and think they are entitled. I understand being poor (barely being able to make ends meet) and doing what you can or not being able to work because of your health but the way I was raised - you don't work, you don't eat. I work hard enough to support myself that I don't need to be supporting Lazy Lou over there that could work but won't. I think there should be affordable health care available but not free health care.

Heeler Lady - everyone us entitled to their opinion. I just have a problem with all the misinformation and scaring the elderly that went on. We should at least stick to the facts while debating the merits of any proposal. While I certainly agree with you that health care is not a right (very few things actually are), the question is whether it is a good thing for our society at large. It is pretty difficult for someone making $2000 a month to pay $1000 a month for insurance for their family(which is the average for a family). These are working people. (Those who don't or can't work are already covered by Medicaid.). So what do these working people whose employers don't offer healthcare do? They go without until their kid gets sick, or breaks a leg, or their treatable conditions become really serious and then they go to the hospital because that is the only place they can get treated. The emergency room which is the single most expensive place to get treated. And many ailments which could have easily been treated if caught earlier require very expensive care. And who pays for that today? We all do, because those costs get passed along in the form of ridiculously high medical costs that we all pay for treatment. You are already paying for those costs today, just in a terribly inefficient way. All the new healthcare bill does is sets up a system that allows people to get care up front, from doctors including preventive care which lowers much more expensive care down the line. This lowers the costs for everyone and, most importantly significantly increases the degree to which these people are ABLE to keep working and contributing to society. This is in all our best interests, not just those who will be able to get access to medical insurance for the first time. Any idea that this is a Government run healthcare system is just bunk. It is the same doctors, the same hospitals, and the same insurance companies that we have today. All that changes is that people without insurance from their employers will get tax credits to buy the same insurance others get today. For those whose taxes will pay for this (i.e. me), we get the benefit of eventually lowering healthcare costs or at least stopping the untenable increases.

Personally I think the bill would have been much better if they had kept in the provision for a government insurance option (which the Republicans getting big dollars from insurance companies fought viciously). That would probably be the only thing that will keep the insurance companies honest. Insurance companies keep 30% of every medical dollar spent in this country. That is money that does nothing for anyones quality of care. In contrast Medicare keeps less than 3% for administrative costs. Doctors offices have to hire people to do nothing but deal with getting paid by the insurance companies. Many doctors have decided it is not worth the hassle and stopped practicing. If someone prefers private insurance, fine. But that shouldn't prevent others from having a choice. But that did not make the law. So the insurance companies will continue their ridiculous rate hikes. A 40% increase this year alone (12-25% every year for past ten years).

At this rate very few people will be able to afford medical care at all. Fine for the haves but the growing group of have nots are out of luck. And the vast majority of those will be in what we used to call the middle class.

you don't work, you don't eat.

This really made me laugh Heer Lady - I've never expected that you will be quoting an official communist sayings which originates in the good old USSR - and one of Stalin's favourites. Quite funny, if you think of it.
What is not funny is that anyone on this forum could be so lacking in human compassion, as to believe that. Many of us do not work, or had to give up work, no matter how much we wish we could carry on. Many other people cannot find work,and are desperate work but there is no work. So such heartless statements are hard to hear.

Pen, I am so glad that you had such a positive experience with the pain clinic - it is good to know that they seem to tackle and understand pain issuesn and all that is involved. I hope they will be able to help you with your pain.

BTW, I want to correct something I said about malpractice costs in NHS: apparently any legal penalties paid due to malpractice suits, are paid out of a separate governement fund, and do not affect patient care as such. My apologies.

Petzi - I have seen most of MM amazing film and it was truly shocking the way that millions of people in US are left with no medical care of any kind, and are often left dying in agony with no hope whatsoever of getting any medical help. This puts statements as the one above, in quite a new light.

Migrainegirl - it does not surprise me that some of the big businesses, politician and big companies are up in arms and try to de-rail any new health insuarnce measures to make health care more affordable for American people, they obviously fear that the current system of making indecent profits out of human misery, by ever raising costs, is going to be checked and restricted.
Of course they say anything to protect their ineterest, and they will always find people who are prepared to believe any lies, provided it is repeated often enough.
I am so glad that well informed people are prepared to have their say and talk some common sense so we from outside can get more balanced view and understand better how or why the current system is failing so many of our friends here.

To an outsider, it seems obvious that one of the problems with the current system in US, is that it is so complicated. To make it more simple would vastly reduce costs of management to all parties concerned, saving billions of administrative costs involved in everybody chasing everybody else, and everybody questioning everybody - in this alone, one system would be already a winner.

Like we all pay our NI, which is clear and everybody knows what they will get for it. I believe similar sysytems work in other countries as well, so we all know what we are entitled or not = less time wasted on arguing if the medicine, or treatemnt is aprroved, or not. This BTW only an example that one system can work better then many fragmented ones.
But I hope no matter what system is chosen in US, that it will work for all those people who are with no insurance who suffer needlessly at the moment.

And how are YOU Dawn? how is YOUR head pain???

Sweetheart, I don't recall you replying yet .....

Risa