No defence for healthcare tourism

Not entirely convinced by opposition to measures designed to stop health tourism. To be clear nobody is going to be denied immediate critical care; you're not going to get thrown out of A&E bleeding to death if you cannot prove who you are. Seems to me the people who will largely be inconvenienced are those not entitled to 'free' treatment, which is pretty much the point, and almost certainly the source of the disgruntlement.

I know people wail about the bureaucracy of it all, but you do actually need some sort of administration to get most things done. Collecting basic identity information about patients is the necessary first step in all medical treatment. Every time I go to my GP or the hospital I'm asked to confirm my details. The first time I visit a new facility I'm asked to verify who I am. This is good practice, not because it prevents health tourists, but because it gives medical professionals access to information they need to treat you properly.

It's really not too much trouble for most people to verify who they are if they want ongoing healthcare. Admittedly, there may be some challenging circumstances, some patients have special needs, but binning off faux-moralistic preaching there are processes in place to deal with them. We may not have a utopian system, but it deals with millions of vulnerable people every year without bodies piling up in the streets (bodies blocking beds is far more common).

The real problem seems to be the myth of 'free' NHS treatment, which is precisely what attracts health tourists. Those who moan about denying 'free' treatment to ineligible patients too easily forget it's not really 'free'; someone always has to pay! People up and down the country have to work hard to fund the system, a system that is always, and always will be, financially challenged.

Not quite Priapus

I picked up the results of my third andrology test last week, the one I did in late September. The result was pretty much the same as the other two; I’m still showing traces of immotile sperm. This basically means I have low fertility, low enough to make conception very unlikely, but not completely impossible. With that in mind the GP is reluctant to sign off on the vasectomy, instead he’s written to the consultant for comment, and has given me a form for a fourth test.

Whilst it’s nice to indulge the notion that I’m just so damn fertile a vasectomy couldn’t stop me, it’s getting annoying now. I’m going to delay the next test till I hear back from the consultant. I was aware it didn’t always work, but I seem to be in the zone where it has pretty much worked but a small risk remains, the key is to quantify it and decide what comes next.

The real reason the GP wanted me to see me was to talk about the Nephrologist’s recommendation that we review my blood pressure medication and also get a Hep B screen and vaccination tied in with my January bloods. The Hep B screen is a pre-emptive measure is to protect me from risk of further kidney damage, but would probably need to be done in advance of dialysis anyway. Unfortunately, I haven’t taken any blood pressure readings since before my last nephrology appointment, so I need to do some and send them into the surgery so he can decide if action is needed.

Whilst I was there I also got my annual flu jab. As a member of an ‘at risk’ group I get a reminder every year, but last year I was able to get one at work from the occupational health team. This year work decided to cancel blanket (optional) inoculation of staff on the grounds that it’s unnecessary (basically a cost cutting measure with an epidemiological backstop behind it), although ‘at risk’ groups were encouraged to see their GP. The GP himself was most bemused to hear this, apparently this year’s strain is particularly virulent and my employer may come to regret the decision. So, there we go, I have been warned, but then I’ve been inoculated too!

Recruitment ineptitude and IKM test claptrap

Going off topic again, but hell it’s my blog, and this deserves remarking upon even if just for sake of catharsis. I believe sometimes in life you come across stuff that is so shit it actually took a special effort to be that shit; this is such an occasion.

I recently applied for a different role with my employer, a small step up the hierarchy, in a different department, but at a level I’ve operated at before. It was in the area of data visualisation, a currently trendy niche of Business Intelligence (BI). I’ve worked in BI for years, and data visualisation has been a significant part of that. I’m actually pretty happy in my current role, and there are significant dis-benefits to moving, but unfortunately it is about the only way someone like me can progress upwards so I had to try.

The spec asked for experience of one or more of a bunch of BI tools, there are lots of these out there, they’re much of a muchness and if you can use one you can normally pick up others quickly. I’d used some, but not all of them; and as none were listed as essential that was a tick. The spec also asked for experience and knowledge of a range of areas that are tangential or peripheral to data visualisation and BI. I have such experience, they are specialist areas in their own right and I’m not a specialist in them, but I’ve worked alongside side such specialists for a long time so know the ropes, just not to their level of expertise.

All this I made clear in my CV and covering letter, and that got me through to the next stage, an IKM technical assessment. This is where things took a turn for the bizarre. The test was supposed to be focused on data visualisation, but it only very briefly touched on the subject. Instead there were highly detailed questions on three of the software packages, two of which I’m not particularly familiar with, and none of which are regarded as leaders in the data visualisation space (curiously the job spec does pick out the leaders and I do have experience of them). The rest of the test was highly detailed questions relating to specialist areas tangential or peripheral to data visualisation.

I strongly suspect this IKM test was never designed to be about data visualisation, I’d estimate that less than 10% of the questions were specific to that subject. Instead it looks like someone, not really knowing much about data visualisation, bodged together parts of tests intended to assess certain other specialist subjects and called it a ‘data visualisation test’. It could be that IKM doesn’t have a genuine data visualisation test, it is quite niche, or it could be that the recruiting department asked IKM to bodge together some sort of weird multi-specialism test (the questions were too detailed to be general knowledge, but covered too many specialist niches to be on any one specialism). Whatever the truth it took some effort to put together something this shit.

I’ve made my feelings known to both IKM and to HR, but don’t expect any response. I’m just pissed off I wasted my time. Either the job title and spec should have been changed to reflect the essential skills required (I am sceptical about the number of specialisms required, as they’d typically be spread over four or five specialist roles in  a data and analytics team) or the test should have been focused on data visualisation with less detail on tangential and peripheral roles. My annoyance is tempered by the fact that success in gaining the role would have involved moving to a less convenient location, in a department that has a bad internal reputation for being inflexible, bureaucratic and generally behind the curve. The grass was never going to be greener on the other side, but it was at least a stepping stone. 

Sliding towards the inevitable

So, my appointment came and went three weeks ago now. After all my fussing about weight gain I ended up weighing in at 113kg, which was 2kg above my previous appointment, but pretty much where I’ve been for the last year.

 

As it was the Consultant didn’t give me a hard time, mainly because my eGFR has shown its first significant decline in a couple of years. She did warn me not to read too much into it, as individual readings can fluctuate significantly, but it does appear I’m starting to shuffle off the plateau. Her best guess is that I will need a transplant in somewhere between six and ten years to avoid dialysis.

 

It’s hard to predict this with any great accuracy, as the majority of my readings are stable and the amount of protein in my urine is relatively low versus my eGFR which apparently means I’ve got a chance of edging towards the furthest end of that timeline. The big danger is that I suffer some form of serious illness, which would accelerate the decline. Touch wood, no such thing happens, but it is something I need to be wary of.

 

I’ve known for several years that failure was inevitable, but I had hoped to delay it for as long as possible. Now I’m at the point where I know the clock is ticking and the challenges ahead are starting to crystallise. In an ideal world a close blood relative would offer me a kidney, as that would provide the best chance of compatibility, but as my Mum and my brother only have one kidney each; that just leaves my sister who has never been tested for kidney disorders or my Dad. I’d be worried about my sister being a donor if only because the odds of her having some form of disorder have got to be high, as for my Dad, I’m not sure about him either as he has suffered from heart arrhythmia in the past.

 

I suspect that my best hope will be from an anonymous donor; likely involving time on a waiting list, fortunately as I’m relatively young, strong and healthy this perhaps isn’t as risky as if I were older and more fragile. The target weight of 100kg will become of greater importance, the 13kg or so to that destination are proving stubborn, but five years ago I was over 130kg, so I know it is possible. I know medical science is moving apace when it comes to artificial and cloned organs, but I suspect that any breakthroughs will come too late this time round (but given my age it is not inconceivable I will benefit in the future). I may also need to re-evaluate my feelings on presumed consent for organ donation, now my life may depend on it!