Suggested topics and stages for actions:
At the doctor’s
A patient enters the room and tells the doctor what he (she) is suffering from.
The doctor asks the patient to strip to the waist and examines him (her).
The patient asks the doctor what’s wrong with him. He seems to be worried.
The doctor tries to comfort the patient and writes out a prescription.
At the bedside
A girl complains of a sore throat.
Her mother is worried. She takes her temperature, its normal. Her throat is all right.
Then the girl pretends to have a stomach-ache and a headache, to be sick and giddy.
Her mother understands her tricks and orders her to go to school.
Exercise 9. Role-play these interactions with your fellow-students.
You are on a tour in Great Britain. One of the tourists has a very bad cold. A doctor is called and you have to act as an interpreter.
You meet an acquaintance of yours, a young doctor. Yesterday he (she) had his (her) first patient.
You drop in at your friend’s to find her/him in a pretty bad state.
You are running a bad temperature. The physician comes to your place to examine you.
Recommended topics for exam
Health service in Great Britain.
Health Service in the United States of America.
Health Service in Russia and changes which have taken place in it during the last ten years.
Dentist’s service in Russia. Tell about your last visit to the dentist.
Ambulance Service and Casualty Department. What do they exist for? How do they work?
System of local clinics in Russia, what doctors work there. Your last visit to the doctor.
Being ill.
How to keep fit.
The national health service
The National Health Service (NHS) came into existence in the United Kingdom in 1948, to give completely free medical treatment of every kind to everyone needing it both in hospital and outside. Its fundamental principle from the beginning was the idea of equitable access for all, regardless of wealth. Since then some payment has been brought in for one item after another, beginning in 1951 when patients had to pay a small fixed amount for pills or medicines prescribed for them. Children, pregnant women, old people and the poor have been exempted from some of these charges, but in 1988 the Government began to abolish some general exemptions for pensioners.
People who are ill go first to see their general practitioners (GP), who treat minor illnesses themselves. These family doctors work alone or in partnerships from surgeries or bigger urban medical centres, and when necessary go to see patients in their homes. Everyone is normally on the list of a general practitioner (or family doctor), who keeps full records of all treatments and over the year gets to know the 2,000 or more people on his or her list. Each GP was paid a fixed amount related to the number of patients on the list. This system of payment was changed after the reforms in NHS about which we shall speak later. Many of those on the register will hardly ever visit the GP. Others, the old, the very young, the infirm and the depressed, may be regular callers at the doctor’s surgery. On a normal day a GP might see about 35 patients in surgery, and make perhaps up to 10 home visits to those who feel too ill to attend surgery. The strength of the system lies in a good working knowledge of the families and individuals in the catchment area, their housing, lifestyle and employment conditions. Good GPs build up an intimate knowledge of their “parish”, and take into account not merely the specific complaint of a patient but also the patient’s general conditions of life.
General practitioners refer people to hospital, if necessary, for more specialised treatment, also free of charge both at outpatients’ clinics and for those who have to stay in hospital. Over 80 per cent of the costs of the NHS are funded out of the income tax system. The balance is paid for out of National Insurance contributions and from the prescription charges.
Doctors and others who work in hospitals are paid salaries, full time or part time, graded according to their jobs, with consultants at the top.
England is divided into fourteen regions based on university medical schools (not on counties); each region is divided into about ten to fifteen districts, based on minor hospitals. Regions and districts have governing boards appointed by the Secretary of State for Health.
Most dental treatment is carried out in the dentists’ surgeries which are scattered around the towns, though difficult cases are sent to dental hospitals. The dentists are paid from health service funds for each item of treatment. At first their patients did not have to pay, but later part-payment became necessary, and now people must pay even for check-ups which find nothing wrong. Only children and few others are exempt.
Eye tests are usually done in opticians’ shops; they too must be paid for, as well as any glasses which are needed. Payment for the eye tests was introduced in 1988, although it was argued that some people would be deterred from going for tests which could have detected incipient blindness in good time. People who are found to need further treatment to their eyes are sent to eye hospitals, where treatment is free.
People do not go directly to hospital unless they are victims of accidents or for some other reason need urgent treatment. They go to the casualty departments, which, unlike GP’s surgeries, work continuously, mostly receiving people brought in by Health Service ambulances.
On the whole the system has worked extremely well. It has been the envy of many countries with less satisfactory systems. The cost of providing the service has always been enormous. By the late 1980’s, the health budget reached one fifth of all public spending. 66 per cent of this budget provides hospital and community services, while 30 per cent funds family practitioner service, the GPs, dentists and pharmacists. There has always been little flexibility for reformers, since over 70 per cent of the budget goes on staff costs.
During the 1980’s the government applied tight financial measures to improve the NHS efficiency. Hospitals were persuaded to discharge patients from hospitals earlier than had been the case. The average stay in hospital now has a reduction of 20 per cent. For the NHS such stringency was extremely uncomfortable, for as leading health professionals point out, Britain spends proportionately less on its health service than any other of the 20 industrialised members of the Organisation for Economic Cooperation and Development (OECD).
In winter of 1987-88 the NHS moved into a state of open crisis with the sudden closure of 4,000 beds all over the country, and the President of the three Royal Colleges, of surgeons, physicians, and obstetricians and gynaecologists warned that the NHS had “almost reached breaking point”. This crisis persuaded the government to embark upon the most fundamental reforms of the NHS since its foundation 40 years earlier. Hospitals now operate on contracts, with some of them being allowed to opt out of control by the district health authority, to become self-governing “NHS-trusts”. General practitioners are paid not, as hitherto, according to the number of patients on their register, but according to health screening targets to ensure that all their patients are regularly checked for early detection of such things as heart disease and cancer. GPs are expected to perform minor surgery, something in the past referred to hospital referrals.
There has lately been a big increase in private medical treatment, and more people have their own health insurance. There are a number of private medical insurance schemes in the country. The biggest is BUPA. Such schemes are becoming increasingly popular. This is not because people believe that private treatment is any better than NHS treatment from a medical point of view. But it is widely recognised as being more convenient. People are not obliged to use National Health Service, and from the beginning a few have gone to doctors practising privately, paying them for their services. This is done mainly for specialist treatment, including hospital. Almost a tenth of the people now pay for their own insurance against possible costs of private specialists and private hospitals. Many senior medical specialists and surgeons work part time for the health service and part time for private fee-paying patients. Many private hospitals have their own operating theatres for surgery, though some National Health Hospitals with their more comprehensive facilities, also have private wards (‘amenity beds’ or, more crudely ‘pay beds’). People who pay for themselves, with or without the help of private insurance, can choose their specialists and do not have to wait their turn for treatment. They also have private and comfortable rooms in hospitals, instead of being in large wards with other patients. But the recent big increase in private health insurance seems to reflect a decline in public confidence in the National Health Service.
(Peter Bromhead, Life in Modern Britain)
Exercise 1. Answer the questions.
1. When was the National Health Service created in the United Kingdom? 2. What were the reasons to create such a service? 3. Is the National Health Service of the UK free of charge? 4. Are there any categories of people which are exempted from charges? 5. Where do people who are ill go first? 6. What is a GP and what is the strength of the GP system? 7. Do family doctors work alone or in the partnership with some other doctors? 8. How many patients are usually included into a family doctor’s list? 9. Where do people who need a specialised treatment go? 10. How and on what basis is the country divided for providing medical service? 11. Where is the dental treatment carried out? 12. In what way is dental treatment charged and who are exempt from it? 13. Where can a person who needs an eye test go? 14. What persons are provided medical treatment in the casualty departments? 15. What are the main reasons for the steep rise in the cost of the NHS? 16. What reforms did the Conservative government introduce for hospitals and GPs from 1990? 17. Are there any other medical services in the UK apart from the National Health Service? What are they? 18. How many people pay now for their health insurance? 19. What privileges have the people which use the private medical treatment? 20. Compare the situation in Britain with that in your own country.
Exercise 2. Visual interpretation.
Consider graph #1. The following are all conclusions some people have made about the NHS compared with the health service in comparable countries:
The British probably get best value for money.
Britain is underfunding its health service.
Britain’s health system is unsophisticated and old-fashioned.
What is your opinion? Find evidence in the text to support your view.
C
onsider
graph #2. The following conclusions have been made by some people
about the private medical care in the UK.
The British widely use private system of medical care.
NHS is still popular among people in Great Britain.
Private system of medical care is more efficient and provides better service to population.
What is your opinion? Prove it with evidence from the text.
THE MEDICAL PROFESSION
IN THE UK
Doctors generally have the same very high status in Britain that they have throughout the world. Specialist doctors have greater prestige than ordinary GPs, with hospital consultants ranking highest. These specialists are allowed to work part-time for the NHS and spend the rest of their time earning big fees from private patients. Some have a surgery in Harley Street in London, conventionally the sign that a doctor is one of the best. However, the difference in status between specialists and ordinary GPs is not as marked as it is in most other countries. At medical schools, it is not automatically assumed that a brilliant student will become a specialist. GPs are not in any way regarded as second-class. The idea of the family doctor with personal knowledge of the circumstances of his or her patients was established in the days when only rich people could afford to pay for the services of a doctor. But the NHS system has encouraged the idea to spread to the population as a whole.
Most GPs work in a “group practice”. That is, they work in the same building as several other GPs. This allows them to share facilities such as waiting rooms and receptionists. Each patient is registered with just one doctor in practice, but this system means that, when his or her doctor is unavailable, the patient can be seen by one of the other doctor’s colleagues.
The status of nurses in Britain may be traced to their origins in the nineteenth century. The Victorian reformer Florence Nightingale became national heroine for her organisation of nursing and hospital facilities during the Crimean War in the 1850s. Because of her, nurses have an almost saintly image in the minds of the British public, being widely admired for their caring work. However, this image suggests that they are doing their work out of the goodness of their hearts rather than to earn a living wage. As a result, the nursing profession has always been rather badly paid and there is a very high turnover of nursing staff. Most nurses the vast majority of whom are still women, give up their jobs after only a few years. The style of the British nursing profession can also be traced back to its origins. Born at a time of war, it is distinctively military in its uniforms, its clear-cut separation of ranks, its insistence on rigid procedural rules and its tendency to place a high value on group loyalty.
(James O’Driscoll. Britain.)