TY - JOUR T1 - Cracking the system JF - British Journal of General Practice JO - Br J Gen Pract SP - 734 LP - 735 DO - 10.3399/bjgp08X342462 VL - 58 IS - 555 AU - Robbie Foy Y1 - 2008/10/01 UR - http://bjgp.org/content/58/555/734.abstract N2 - I took a moment to listen to his breathing. My heart sank. Even without the aid of a stethoscope, it sounded like stridor and, given his age and past smoking, a bronchial carcinoma until proven otherwise.It had not been an easy trip for my Dad who, accompanied by Mum, had fallen through the system when their first connecting flight from Glasgow had been delayed. It subsequently took them five flights and over 48 hours to reach Los Angeles. They had come to visit me while I was on a year's Harkness Fellowship studying approaches to improve healthcare quality. Back in the UK, I worked a day per week as a GP as part of an academic post and didn't consider myself an especially astute physician compared with my more experienced peers. But I am wary of the dangers of inappropriate medicalisation, especially having spent a good deal of time in the past trying to protect Dad from the medical system. I'd failed to avert him from the literal treadmill of cardiac investigation for what I'd always strongly suspected to be psychologically-related chest pain. He presently appeared to have stridor and breathlessness on fairly minimal exertion. He had seen his own family doctor twice in the past 3 months and initially been prescribed an inhaler for ‘bronchitis.’ I might have done something similar myself.Now he was thousands of miles away from our cherished British NHS. I knew the NHS wasn't perfect. I once sat next to an American attending a healthcare organisation conference in the UK. Following presentation after presentation on organisational problems within the NHS, he turned to me in amazement: ‘Hey — I thought you guys loved the NHS. I never knew it was such a mess!;’ But the NHS works well on the whole and we … ER -