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Offline Grandhoux

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International Differences
« on: April 30, 2009, 12:47:45 PM »
After reading a number of posts throughout this forum I can't help but be surprise at the difference in post operative help and PhysioTherapy between countries, particularly the UK and US. I had my vehicle accident and immediate Tibial Plateau Fracture surgery in France. A plate and 7 screws. That part seems pretty standard although the antiquated XRay equipment meant that at least one of the screws went a bit awry and is now trying to come out!

The surgeon suggested that I would be out of plaster in 6 weeks and weight bearing, back at work in 3 months. They tried to get me doing leg exercises and using crutches the day after the accident and surgery but my other injuries from the seatbelt and impact as well as two broken ribs prevented me from using the crutches much. The main emphasis is France was the use of anti-coagulants, bordering on the obsessive. Lab tests, graphs, tablets injections. Not just me but anyone with a leg in plaster and it was meant to go on for at least a month. On my return to the UK (by ambulance through the tunnel) I passed on the notes to my GP (doctor) who 'asked around' and then said "we don't bother in Britain." Not only don't we bother, the medication just isn't available.

I had my first appointment with a surgeon in Britain after 3 weeks. He looked at my XRays, said 12 weeks non weight bearing and spent a lot of time saying how bad my arthritis will be in a few years, how pleasant! I returned 3 weeks later to see the actual consultant who agreed, 12 weeks nwb but let me flex the knee fully. He was more bothered with a bone fragment which he would have put an extra screw in which might 'come adrift'. Another 3 weeks later, some 10 weeks after the accident and surgery yet another doctor, in a really dismissive manner, asked why I was still in a wheelchair and not walking. He put me down as 'full weight bearing' and signed me up for Physiotherapy.

6 weeks after being told I was 'full weight bearing' yet another doctor (my 4th) said that one of the screws was coming out, I had walked too early and one side of the knee is collapsing. This was 5 weeks ago, I was told to go back to wearing a leg brace during the day and he was reluctant to allow me to walk. I now have PT with my leg brace on. I am due back at the clinic next week (19 weeks after surgery) and hope to get a date for all the hardware to be taken out. Hopefully I will see the consultant, who I have only seen once in 5 months!

as for PT, I have had 6 x 15 minute sessions, in 2 months, now down to every 3 weeks. My flex and extension have never been measured, I have had XRays but no scans. No exercise machines, written exercise sheets or planned exercise regime. I have been shown a number of exercises and told to 'do them a few times a day'. The PT has never dealt with a Tibial Plateau Fracture before so in his own words he is 'making it up as he goes along'.

Now, I know our National Health Service is overstretched and that people in the US and France pay a lot more for their health care but I haven't even been given the option. The attitude in Britain seems to be 'do the minimum necessary' whereas in the US it's 'get the patient mended and back to work'. Personal contact with the surgeon in Britain seems frowned upon. Without being racist, I have had trouble talking to my doctors as they have all been from overseas and their accents and command of English have been far from perfect. I also have trouble with remembering their names. The consultant is better (Egyptian) but I have only seen him once, you don't get to choose who you see.

This is life with the NHS!
Accident in France 1st December 08. TPF, plate and 7 screws
22 weeks later, now only 6 screws!
11 months, slipped and broke Femur. Plate and further 10 screws in femur
16 months now only 15 screws, another came out!
2 years hardware removed.
January 2012 High Tibial Osteotomy to straighten leg.
tkr?

Offline ipswich1984

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Re: International Differences
« Reply #1 on: May 01, 2009, 07:21:49 AM »
I totally agree about the NHS, I had a TTT & LR 7 weeks ago after the op after being told I would be in for 3 days, they discharged me the same day with just paracetamol for pain relief.
I hardly ever actually see the os, always his registrars.
November 2005 - Arthroscopy RK.
December 2006 - LR RK.
Febuary 2008 -
RK Subluxation. Back to physio.
October 2008 -
Put on waiting list for TTT/LR.
Told I have Hypermobile joints.
March 2009 -
TTT/LR RK.
11th Jan -
OS agreed removal of screws
5th Feb 2010 -
TTT/LR scheduled for LK

Offline Silkncardcrafts

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Re: International Differences
« Reply #2 on: May 01, 2009, 08:25:18 AM »
If you go privately in the UK it is a totally different story. I experienced that when I lived in London for 3 years and attended a private sports medicine clinic.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline Grandhoux

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Re: International Differences
« Reply #3 on: May 01, 2009, 01:32:00 PM »
As my vehicle insurance was with a French company I will get personal injury compensation and any medical expenses paid, unfortunately that's in France and as yet I don't know how to get any money out of them for private treatment, if I can. I'll be seeing a French solicitor in a couple of weeks so may know more then. In the meantime I have been passed 'fit for work' for the past two months by the UK Works and Pensions Department even though I'm back in a leg brace awaiting a further operation. I just love this country!

As for pain relief, I just go to 'Doug the Dealer' ... my GP.  ;D Anything I want, I can get ... "just don't ask for time off work!". Actually, he's been brilliant. Instead of painkillers he said to buy Paracetemol and Ibufrofen from the supermarket and supplement it with codeine which he prescribes 100 x 30mg a time. I manage with just two per night, usually, sometimes 3, occasionally 4. My Physiotherapist has also said that it's been proven anything less than 600mg of Ibuprofen doesn't really touch joint pain although I try to stay away from them as much as possible as it's said they can inhibit bone healing.
Accident in France 1st December 08. TPF, plate and 7 screws
22 weeks later, now only 6 screws!
11 months, slipped and broke Femur. Plate and further 10 screws in femur
16 months now only 15 screws, another came out!
2 years hardware removed.
January 2012 High Tibial Osteotomy to straighten leg.
tkr?

Offline Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
Re: International Differences
« Reply #4 on: May 01, 2009, 04:12:18 PM »
I read your thread about the NHS with interest as I found the way my knee problem was delt was unaccepatable the way I was treated by the NHS. Fell over and hurt my knee in October 2007 and see an OS for the 1st time on the 23rd April 2009, 18 months lator and saw him privately as the NHS took too long to refer me to an OS.

Saw 3 PTs over the 18 months and they or came to the conclusion that my right knee is ok and knee pain and not being able to run is all in my head. The NHS was ment to give me an injection in January 2009 but the OS decided he would not go ahead with injection on the day of injection saying my knee normal just because its says so on the MRI scan.

I saw a well known OS called Mr Green 23/04/09 at a Birmingham private hospital and he found the problem staight away and gives me a steroid injection that the NHS OS should have given. The NHS OS did not even bother to examine my knee but Mr Green did and found a very painful area which all the other PT's could not find so makes me wounder do they need to go on a refreshers course once a year.

The last PT I saw on the NHS said knee pain and problem in my head and should be able to run if I listen to music on my ipod to take my mind of my knee injury. Mr Green thinks I may have damaged the bottom of my knee and tibia when I fell onto the pavement. I had a bad experience so far with the NHS and can say they pants with the way they delt with my knee injury.

I asked my PT if I could see Mr Green on the NHS but he ignored my request and reffered me to another OS but cancelled him and went private. I am now on the way to see Mr Green for follow up appointement on the NHS. Even he reluctant to scope my knee even though I cant run and feel catching and pain inside the knee and said if you can live with it avoid surgery. I cant live with knee problem and he has to sort it out a for me and he said he happy to operate if I want him to.

I noticed this alot with UK OS's dont like to scope the knee while in USA & France they would have sorted it out by now. Sorry for such a long reply, but thought I share my story as I like others to know how the NHS delt with my knee injury.

Sorry to hear about your car accident but at least they one consolation that you are going to get personal injury compensation. Yes supermarket drugs are cheaper then well known brands and do just as good job as the more expensive paracetemol and ibufrofen.
 
Hope you have better luck in future with the NHS and recover well when you have your next surgery.

Nick :) {2009} :)





« Last Edit: May 01, 2009, 04:28:59 PM by Clarkey »
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline Grandhoux

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Re: International Differences
« Reply #5 on: May 01, 2009, 06:18:26 PM »
Thanks, Nick. Your story is terrible, unfortunately there doesn't seem to be anywhere you can go to complain these days. With all the NHS 'targets' at least you get your crap treatment quicker! It all comes down to politics; for years the parties have been selling us the idea of 'lower taxes' whilst covering up the fact that we get rubbish services.

I really feel strongly that we need a National Health Service but not a second-rate one. If this means taking out insurance for 20% of the cost of treatment as they do in France then I'd rather do that than suffer the health consequences of an underfunded NHS.
Accident in France 1st December 08. TPF, plate and 7 screws
22 weeks later, now only 6 screws!
11 months, slipped and broke Femur. Plate and further 10 screws in femur
16 months now only 15 screws, another came out!
2 years hardware removed.
January 2012 High Tibial Osteotomy to straighten leg.
tkr?

Offline sooz

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Re: International Differences
« Reply #6 on: May 02, 2009, 11:36:27 AM »
Hi Grandhoux,

I think the NHS targets are the route of the problems, eg, A&E patients have to be 'processed' through A&E in four hours. In my case, I was in A&E for just under four hours having been transported there by ambulance after a road accident. The hospital was particularly busy that morning as there had been other road traffic accidents and I waited in the ambulance in a queue. I was on a back board at the time, but after three hours or so the A&E doctor took me off the board saying I hadn't broken my back. I had some X-rays which were probably done quickly and taken to an observation ward where the A&E doctor said he would push for an MRI scan of my knee as my knee was very swollen. The A&E doctor had no influence over the ortho surgeon who visted me in the observation ward who told me to walk which I couldn't do. I was admitted to a ward and discharged after two days upon recommendation by a physiotherapist! I went back to outpatients a few days later, when I was told that I hadn't broken anything. I insisted on a scan and said that I wouldn't leave the hospital until I got one. Eventually, I got a CT scan, rather than MRI and the next minute, my leg was put in plaster because the scan revealed a TPF fracture. Three weeks later, I got a letter from my GP advising me of of the fractures in the vertebrae in my spine. Had there not been a rush to get through A&E within the four hour time target, then perhaps, my injuries would have been diagnosed properly in the first place. I was told that GP's can get MRI scans more quickly than the hospital. Of course, if MRI scans aren't ordered, there aren't any targets to comply with.

I agree, I would rather pay more NI or have an insurance to contribute towards NHS costs in order to improve what's going on.

Your treatment since returning to the UK sounds worse than mine. Have you explored the "patient choice" scenario?
« Last Edit: May 02, 2009, 11:40:49 AM by sooz »
Oct 08 hit by a car, TPF (medial), vertebra (back) fracture, discharged from hospital after 2 days with crutches, after 1 week leg put in plaster, then changed to brace. Brace removed Nov 08, ROM 67. Feb 09 ROM 105, Apr ROM 135, still on crutches. May - 2nd opinion. Aug MRI waiting 4 results & rehab

Offline Grandhoux

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Re: International Differences
« Reply #7 on: May 02, 2009, 01:39:15 PM »
Have you explored the "patient choice" scenario?

Never heard of it!

I'm hoping that when I get the French solicitor going with the French insurance company I might get some private treatment. Until they say it's OK I'm not risking spending money I don't have. I've decided that at my next appointment with the consultant (in a week) I'm going to insist on seeing the consultant, not one of his registrars as I'm worried about the lack of progress.

I'm also going to need a complete set of medical records for the insurance company, might make interesting reading. What may also be interesting is what the French insurance company make of the treatment, if they feel it's been negligent or poor will they argue the level of compensation or even sue the UK hospital themselves? Interesting ... but concerning at the same time!  :-\

Dave
Accident in France 1st December 08. TPF, plate and 7 screws
22 weeks later, now only 6 screws!
11 months, slipped and broke Femur. Plate and further 10 screws in femur
16 months now only 15 screws, another came out!
2 years hardware removed.
January 2012 High Tibial Osteotomy to straighten leg.
tkr?

Offline Silkncardcrafts

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Re: International Differences
« Reply #8 on: May 03, 2009, 11:26:39 AM »
Hi Grandhoux,

What part of the UK are you in ?

The NHS now has now has orthopaedic and sports physicians. I have found a website that maybe useful. They may be able to put you in the right direction.

Just so glad that I am living back in Australia and get great treatment.

We have a medicare system here which is much better than the NHS. Basically when you go and see a doctor you get a rebate from the government. That way you can choose the doctor you see.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline Grandhoux

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Re: International Differences
« Reply #9 on: May 03, 2009, 01:05:39 PM »

What part of the UK are you in ?


Bury, North Manchester.

I intend to demand to see the consultant rather than a registrar at my next appointment this week as I have a number of concerns. One registrar told me I should be full weight bearing too soon and it caused me no end of problems. I am now back to wearing a leg brace to stop my leg bending sideways at the knee. I'll see how I get on.

Dave
Accident in France 1st December 08. TPF, plate and 7 screws
22 weeks later, now only 6 screws!
11 months, slipped and broke Femur. Plate and further 10 screws in femur
16 months now only 15 screws, another came out!
2 years hardware removed.
January 2012 High Tibial Osteotomy to straighten leg.
tkr?

Offline Silkncardcrafts

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Re: International Differences
« Reply #10 on: May 03, 2009, 02:23:01 PM »
Hi Dave,

That is crazy you only saw a registrar. You need the best treatment you can get.

If you are in Northern Manchester, you may want to consider the following:

Dr James Brown, http://www.myorthosports.com/drbrown.php
Dr Robin Chakraverty, http://www.sportsmedicinepartners.co.uk/our-team.html#RobinChakraverty
Dr Roger Hawkes, http://www.sportsmedicinepartners.co.uk/our-team.html#RogerHawkes
Dr Grahame Brown, http://www.drgrahamebrown.co.uk/bibliography.asp

Most of these are sports and musculoskeletal physicians that also work through the NHS.


11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline Grandhoux

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Re: International Differences
« Reply #11 on: May 03, 2009, 03:56:46 PM »
Thanks for that,

I've actually seen the consultant once in 4 visits and a different registrar each of 3 times. Not good, is it!

I'll see what I can get next week, I'll also go to see my GP. Unfortunately you can't just drop yourself onto these people, you need to be referred. The French angle complicates matters. The accident and tpf operation were in France and my vehicle insurance is French. Different languages, different systems and a both dismissive of each other!

I should be clearer in a few weeks after seeing a French solicitor. Maybe the insurance will pay for some private treatment ... but probably only in France!  ::)
Accident in France 1st December 08. TPF, plate and 7 screws
22 weeks later, now only 6 screws!
11 months, slipped and broke Femur. Plate and further 10 screws in femur
16 months now only 15 screws, another came out!
2 years hardware removed.
January 2012 High Tibial Osteotomy to straighten leg.
tkr?

Offline sooz

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Re: International Differences
« Reply #12 on: May 04, 2009, 01:46:28 PM »
Hi Dave, Sounds like you've got some insisting to do! Having said this, I've seen other doctors besides the OC, eg, a junior or trainee doctor working under supervision of the OC and once I saw the registrar. My hospital appointments were every two weeks until eight weeks approx and then every two months. Re "patient choice"  - didn't apply to me as I was taken to A&E by ambulance. Like you, I'd not heard of "patient choice", however, it became evident that others were travelling to the hospital from other areas after having been given a choice of hospital and consultant. Also, I met someone who'd had a knee replacement at a private hospital, courtesy of the NHS. Must be all to do with waiting list targets! Anyway, I investigated this "patients choice" and asked my GP's surgery if they participate. Apparantly, surgeries don't have to participate and even if they do, some GP's prefer to write letters, rather than use the electronic booking system. Anyway, I'd not heard of it either!



Oct 08 hit by a car, TPF (medial), vertebra (back) fracture, discharged from hospital after 2 days with crutches, after 1 week leg put in plaster, then changed to brace. Brace removed Nov 08, ROM 67. Feb 09 ROM 105, Apr ROM 135, still on crutches. May - 2nd opinion. Aug MRI waiting 4 results & rehab

Offline Grandhoux

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Re: International Differences
« Reply #13 on: May 04, 2009, 03:14:20 PM »
OK, Sooz, I know what you mean now. My doctor does use it, but in this case it was an emergency as I'd just been brought back from France by ambulance. Once the treatment has started I think you're stuck with your choice. I must admit, I'm getting a bit worried because of the lack of progress but I'll see what happens on Friday. My wife is threatening to come along to make sure I see the right surgeon and get some answers ... I wouldn't wish that on the poor hospital!  ;)
Accident in France 1st December 08. TPF, plate and 7 screws
22 weeks later, now only 6 screws!
11 months, slipped and broke Femur. Plate and further 10 screws in femur
16 months now only 15 screws, another came out!
2 years hardware removed.
January 2012 High Tibial Osteotomy to straighten leg.
tkr?

Offline Silkncardcrafts

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Re: International Differences
« Reply #14 on: May 05, 2009, 10:11:09 AM »
Hi Dave,

I would insist that you get referred to someone else. The treatment you are getting is appauling.

Dr Browne works at the Royal Orthopaedic Hospital in Birmingham and has directions on his website how you can get referred to him through the NHS.

Just hope you get some answers from the French lawyer. Sounds very complicated.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty















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