Does Peppa Pig encourage inappropriate use of primary care resources?
bmj.com
bmj.com
She got sick so we phoned a clinic. Immediately, we were asked to come down. The doctor talked with us about theories for what was wrong for at least 20 minutes explaining why it was x and not y casually.
He ran a blood test and within half an hour came up with a likely cause. He sent us home while he had another test that would take longer but would confirm his suspicions from the first test. After getting back those results, he texted us on Whatsapp with a picture of the results sheet he received. He then had a medication delivered by motor bike to our hotel.
After 1 week, he followed up again on Whatapp asking if my partner was feeling okay now.
The whole thing cost 40 euros including tests and medication.
I would love to pay 400 euros for that service anywhere in the West.
Maybe Peppa Pig is the right idea and health care just needs to up their game by removing red tape.
My (extensive) experience of South East Asia is that they’ll run many tests which a European Dr wouldn’t order with a straight face but that you don’t care because it’s generally pretty cheap.
At least it has end-to-end encryption.
Apart from in-person (which is inconvenient) what's the alternative? Email? SMS? Post?
Provided it's a "good news" follow-up, of course.
One of the problems is actually that you cannot tell what a certain level of treatment will cost.
These people will hog any system. In some countries they are discouraged by high fees (your 40 euros in Bali are cheap for you but very expensive for locals), but those fees will then become a barrier for a lot of people who really need the service.
I honestly don't know the answer, but there must be ways to create barriers that are porous enough to let the genuinely ill people in and the hoggers out.
Anecdotally, in the UK this now normal. Apparently you have to beat the system by calling at a certain time and saying your problem is urgent. Obviously, all the people you are referring to know all about this; it's just suckers like me who have to suffer.
The NHS is free at the point of use in the UK - except for dentistry which is only free if you have a low income, etc.
Most folks (in my experience) go full on private and pay a monthly fee plus insurance. It isn't expensive (unless you need some major work doing) and the standard of dental care has improved many fold as a consequence.
Although NHS dental treatment isn't generally free for adults, it is pretty cheap. I've been lucky enough to find an NHS surgery everywhere I've lived and the standard of care has been generally excellent.
Maybe the growth of private clinics has had a positive effect on standards overall, though I know a lot of NHS dentists do a bit of both.
And I think essentially all NHS dentists do private work as well these days. The one bit of private work I've had done was a rear filling: standard amalgam was covered on the NHS tariff, but a cosmetic 'upgrade' to a white composite one was private and at cost.
May be good advice in general but I don't think that not being part of the NHS should be seen as something negative.
For example I can book an appointment online at my GPs, so never have to phone anymore. I can normally get an appointment within a week.
Also a number of years ago I needed an MRI and CT scan. I had these 2 weeks after seeing my GP, whereas I know family members that live in a different area and have had to wait months for similar scans.
Edit: For some more data on UK NHS GPs see
* https://www.england.nhs.uk/statistics/statistical-work-areas...
Absolutely, but that's exactly why these barriers exist: because dealing with the hoggers sucks up all available resources. It's not like GPs sit around, their time is still allocated for the most part. In a context where central government keeps squeezing GPs (forcing them to work longer hours for less pay than before), they have no incentive to do anything but to deal with the high-maintenance types. Some sort of external shock is required.
I had a similar experience with my local GP surgery, in a working-class area in the North of England. Doctors kept rotating (they would hire kids and other practitioners with no experience, who would then leave very quickly after they realized what the workload was), it was impossible to get an appointment, and more often than not one would just be dismissed with paracetamol. Then people discovered the feedback tool at https://www.nhs.uk/service-search , and inundated the surgery with bad reviews. This seems to have kicked the right asses in gear, and now it's much better. Mind, I still have to log on Patient Access right after midnight to get a same-day appointment, but at least I don't get dismissed once there...
This mirrors my experience and stories from friends. The GP system just isn't designed for people who work. The only GP I can actually see is a private one near work, which I pay for directly (not covered by insurance - fortunately I rarely need to go).
I have private medical insurance paid for by my employer, but as far as I'm aware no one else I know has private insurance because despite its shortcomings the NHS gets the job done.
Allegedy 1-in-5 NHS GP appointments are no-shows, costing north of a billion squids/year. The total NHS budget is £125Bn so that's nearly 1%. Which doesn't seem like a great deal but when you add on all the other waste such as people filling prescriptions they don't need it's going to be pretty significant.
We need a system where you pay a deposit say £10 for an appointment, refunded in full if you show up on time, say £5 if you are late. Because it has a knock on effect on other patients.
For many people having to pay a £10 deposit to place a doctor's appointment would be the difference between seeing the doctor or not. Especially near the end of the month there are people for whom £10 is the difference between eating or not eating.
We can't just allow people who give no thought to others, who make bad choice after bad choice, the option to continue to ruin it for the rest of us. I'm sympathetic to low income folks, but surely a 10 dollar deposit you get back if you simply do what you say you're doing to do, is not too much to ask?
What would you say that involves? The current budget is £125Bn, so are we looking at £150Bn, £200Bn, £500Bn? Put a number out there and we'll have a national debate on what we are willing to do to finance that.
Noone seems to know what "properly fund" actually looks like, and noone has any appetite for tackling waste, such as missed appointments, or IT outsourcing contracts. £10Bn flushed down the toilet on NPfIT, when you say "save our NHS" you are really saying "save CSC's shareholders", do you realize that?
https://www.theguardian.com/society/2013/sep/18/nhs-records-...
Windfall tax on Accenture et al I say.
Conflating IT mistakes (10bn over 20 years, 500m per year - peanuts, from a government perspective) with the entire NHS expenditure, is just misleading propaganda. This is why we can't have a civil debate on what the NHS should and should not provide: the fixation on cost-cutting and its opposite knee-jerk reactions stifle any attempt at reasoning about actual problems.
That's a really weird thing to say: are you asserting that the "right wing" is complaining about billions in public money being funnelled into the pockets of capitalist shareholders? Or is "right wing" just your word for "anyone who disagrees with me"?
I'll grow tired of it when the government stops doing business with these companies, insources all the IT work, and hits them with a windfall tax to claw it all back. Is that what you call "right wing"?
This is 20% of appointments. I in no way believe that 12 million people in the UK can't afford a fully refundable £10 deposit.
Right now, a lot of British people feel quite protective of the NHS. They see it as a scarce and precious resource that should be used sparingly. Many people feel a real sense of guilt if they inadvertently miss an appointment, because they feel that they're taking something away from someone who might need it more.
Converting this reciprocal relationship to a transactional relationship is very risky. Many people who would otherwise make an effort to keep their appointments could take the attitude that they're just paying for a service; the lost deposit takes away any guilt about missing the appointment. £10 is a fraction of the actual cost of a missed GP appointment, so the NHS could make a substantial net loss.
I think a far more productive approach would be to use behavioural nudges. It wouldn't be difficult or expensive to give an SMS or automated voice reminder of an appointment. People who persistently miss NHS appointments could be offered support in keeping to their appointments, while being gently reminded of the costs to the NHS and the effects on other patients. I suspect that a bit of psychological carrot-and-stick would be far more effective and far less risky.
This is not even slightly true. £11Bn a year is spent on Type 2 diabetes, 80% of which is caused by obesity (source: Diabetes UK). A&E every Friday and Saturday night is full of drunks. People take the NHS for granted.
take the attitude that they're just paying for a service
Well SOMEONE is paying for it. Generally, the people who can't get GP appointments...
The end result was that "late pickups" increased as the shame of being late was replaced with a transaction fee, signalling that late pickups where allowed by the rules.
A bigger problem is that the justice system in India is (almost?) dysfunctional so good luck suing a private hospital if things go wrong. Your only hope is that the media picks it up, which can force the government to take action, e.g. [1].
[1] http://www.thehindu.com/todays-paper/tp-national/haryana-pro...
Doctors offering direct pay are cash only. They charge a small monthly fee. Here in Missouri it’s about $100/month. For that $100/month you get seen the same day!!! I haven’t been able to get seen by a doctor the same day since I was like 5 and that was 1980. Usually it’s a week or so before an appointment can be made. You also get an hour with the doctor. No rushing you in and out to increase turnover. Most things up to minor urgent care are included as well including stitches and lacerations. You only pay for materials used. Which is usually very cheap. A couple bucks for gauze. A couple for stitches. Medication and labs massively reduced from insurance rates. Flu shots are free. Etc
Direct pay providers are becoming more common as more and more doctors say “screw insurance and federal government red tape and regulations”. They are just absolutely done with the mess and pain of insurance and government regulations. Most even provide house calls! House calls! I haven’t seen a doctor do house calls since little house on the prairie!
Seriously if you are in the states look into it! The wife and I are more than likely moving to direct pay with a high dedeuctible catastrophic insurance plan this year and we will be saving over $500/month on our employee provided Cadillac insurance plan.
As a user of GP medical practices, I often wonder why doctors are such douchebags when faced with people who have perfectly fine concerns over what seems to them like trivial symptoms that self-resorbs.
In the show House M.D., Dr. House is a very prominent medical doctor who specializes in very rare diseases and is often dismissive about patient's problems. On 78 occasions during the show, Dr. House talks about the patient as "a lier who's perfectly fine", and refuses to take their case.
Conclusion: Although the show demonstrate accurate and interesting cures to very rare diseases, the way it talks about the average patient is pretty bad, and may help explain why doctors behave like jerks on a variety of occasions
Typical dismissive attitude of most GPs in the UK to make you feel guilty for consulting them.
Having sick children can be worrying and minor ailments can actually be more serious in a child, so it's hard to know when to ride it out and when to seek a second opinion.
Some people think they're rentseeking, some people think they have a point. I obviously have my opinion but I won't push it on you.
What's the reason behind this - government wants them to do more work without more pay? An innate sense that they're doing exactly the right job and why change it?
People go to the doctor because they don't know what's going on with their body and they are worried. They don't know that it's a minor ailment until an expert tells them. I hate this trend for shaming people just for being worried (which of course can be a sign of a mental health condition in itself).
I think the difficulty here is that doctors do have to deal with hugely ignorant people on a daily basis. The fact that many people apparently haven't grasped that antibiotics don't do anything for viral infections is testament to this. (Seriously - there was recently a national NHS ad campaign about this).
While they shouldn’t be making you feel guilty per-se, they’re gatekeepers for the public, finite resource of NHS care, and help stop healthcare spending spiralling out of control.
But the primary care side of things basically has to be a bit shit for the whole thing to work. Because demand for healthcare is so elastic. Almost every single one of us has those little niggles, aches and pains and things that we ought to get checked out.
If we could get a GP appointment at 24 hours notice, and be guaranteed an un-rushed meeting with a sympathetic and friendly doctor, demand would skyrocket. The system has to limit demand by never getting too good.
There isn't really a private alternative because, in the UK, NHS GPs are the gatekeepers of everything. You need a referral letter from an NHS GP to see a specialist on your own private medical insurance. There are some companies with private GPs but they're extremely expensive, presumably because there isn't much competitive pressure.
So the system finds an equilibrium, where it's frustrating but tolerable. Not quite good enough, but not quite bad enough that it's worth paying for a private GP.
I think this is slowly shifting. I have private medical cover via my employer and one of the things included in that is access to video chats with GPs via a mobile app - obviously they can't diagnose everything without being physically present, but they can do referrals for things where its obviously needed. There are a few services popping which offer this sort of thing for a one off fee for each appointment as well.
It's interesting that the insurance companies have noticed the weakness in the NHS system. Presumably they sell this service to their clients in terms of reducing the time lost from attending GP appointments.
I also don't think that services like this are going to be a satisfactory replacement for an in-person visit. I bet they err very much on the side of caution, and are likely to end up sending people back to the NHS if there's any doubt. But for those situations where you just need a referral rubber-stamped they could be fantastic.
I'm sure more expenses on early symptoms and making people ask for a diagnosis when in doubt would end-up as a lot less money used to try curing things at a late stage.
My partner was hospitalized for pneumonia. That was despite seeing a doctor 4 times. Each time the doctor was dismissive about the problems she was having. It was only when she struggled to get out of bed that a doctor said it was time to go to hospital.
This has happened for similar issues attending different doctors for issues such as fatigue (turned out to be low iron levels after an operation) and wrist pain (turned out to be RSI which required multiple cortisone injections and prolonged time off work.)
This attitude makes you not want to attend the doctor unless you become critically ill.
On another forum, I got a UK GP upset that my country suggest people over 40 to see a GP once a year for a checkup. What a waste of resource it seemed to him, he could not believe it.
Well the truth is that in most of the European countries, seeing a GP is simply a non-issue. Even in my in law family village, 70 km away from the nearest city, population reaching 100 inhabitant there is a GP 3 full days a week, free. 8 km from there, there is a 24/7 walk-in centre. I never experienced "you have to wait for weeks to get an appointment" or the "go through the list of common ailment and their cure for 2 weeks before requesting a GP appointment". You are sick, you go to the GP open consultation, he will see you within the hour. Or you call and he will come in the afternoon. That's what GP visit mean in other EU countries.
Before coming to the UK I never had to go to the A&E. Now, I'm really sad to say because it is a terrible waste, but that's my primary care centre (after self medication). My GP has a month waiting list, 2+ weeks if I'm happy to go to a GP that has never heard of me.
I don't think the NHS realise just how far they have been bled out over the years. They rely on statistic and forgot anything about the side concern. Sure maybe seeing a GP once a year when you are asymptomatic 40 year old does not have an immediate ROI. What they lost sight of is the indirect ROI, like GP knowing his patient ? Or even patient knowing his GP ? That has been proven recently that simply trusting your GP increase the efficiency of medication.
Note that A&E has been tremendous. They really helped us understand what to be worried about with small babies and children. But there is nothing (thankfully) they did that a GP in my home country would not have done.
Your GP isn't the first port of call though. People can ask a pharmacist, speak to NHS 111 or read NHS Choices.
From the perspective of a GP, they might find it troubling that, despite continual patient education efforts, patients persist in seeking GP consultations for symptoms of minor ailments rather than opting for a nurse (or even a chemist). Patients can usually be seen by nurses sooner and for longer consultations, with the ability to prescribe and triage for further diagnosis/consultation.
My own idea for why this happens (in a UK context, at least) is that nursing's reputation for basic healthcare skills persists amongst the public, as well as a notion that nurses may be acting 'above their station' in diagnosing and treating patients. The popular idea of nursing as providing basic care and observation is something that tends to be done by healthcare assistants these days. The role of specialist nurses - including nurse practitioners - in recent times should allay such legitimate concerns, but it might be the case that they are encumbered with a low-visibility public presence or status. Another idea that occurs is that it seems to have been part of patient culture for patients to arrange appointments with a family GP when seeking assessment and treatment - a norm passed down through family generations? Changing it or introducing new norms within families' relationships with primary care providers may be a particularly tricky challenge to overcome.
You can call an ambulance if you feel sick enough to not want to go to the doctor (like a 100 degree fever or higher) and it'll cost zero - you do have to pay a subscription that's currently about 20 dollars (on top of free healthcare).
It pretty much works exactly like that in Australia (National Home Doctor service).
You call a number, talk to a call centre person about the symptoms. Then a doctor comes to your house after hours, diagnoses the problem, and supplies a prescription for medicine.
It is 100% free, and government paid. My daughter watches Peppa Pig and has an equivalent experience herself.
For example, I believe that many cases of Trichotillomania (hair pulling disorder) can be attributed to the game Animal Crossing from 2001 to present, due to the weed-picking game mechanic, paired with existing OCD behavior.
EDIT: To the downvoter, could you explain the reason?
edit:proved => provide
Posting a search engine result page is not sufficient, I can do the same to "prove" 9/11 was a conspiracy to enable GMO chemtrails.
If I say "Show X is bad" then people will expect of me to back up this opinion somehow. This can be as easy as citing examples of why but not by handwaving as "I watched it and thought it was bad".
Example; I think Steven Universe is a bad show. I've watched it through to Season 2 yet I found it lacking in character attachment and depth, meanwhile the animation and storytelling was quite good. Overall I did enjoy it but not enough to keep consuming it.
That is how you should have approached this so people would not jump on you. You can explain it but lacking any explanation people will demand it.
Read my response below to another poster.
1. Daddy pig is portrayed as an idiot. In fact, there are no positive male figures in the whole show. Check sexism.
2. All of the animals are married to animals of the same type: there are no "inter-racial" marriages. It is also full of racial stereotypes. Check racism
3. The only person in the show who seems to work, Mrs Rabbit, has several jobs that she does badly (perhaps due to exhaustion) and speaks with a working class English accent (while all of the other characters have upper/middle class accents). Check classism.
4. It heavily promotes the British royal family, especially in the recent movie. Check elitism.
Unless you want to fill your kids full of prejudice from an early age, avoid.
Not as bad as Thomas the Tank Engine, though. Don't get me started on that.
I strongly disagree! It looks that way superficially, but he is highly resourceful and skilled. He's an engineer, a champion diver, and superb musician. In contrast, Mummy Pig is mostly a non-entity.
> All of the animals are married to animals of the same type: there are no "inter-racial" marriages.
Species ~ race is your own, silly, interpretation.
> perhaps due to exhaustion
Or because doing things badly is a core component of slapstick humour.
Are you dismissing me as "silly Daddy" now? Sorry could not resist ;-)
2. Let's teach them realistic biology. They're difference species, how could they possibly have rabbit and elephant parents - what would the child be? But the fact every species is friends with each other suggests it's ok to "mix".
3. Daddy pig goes to work, and what about the Doctor? There's a teacher, policeman, mechanic. (straw-man: you have differentiated class by accent)
4. I'm far from a royalist, but there's no harm in teaching about the royal family and our heritage.
Disclaimer: I enjoyed watching Peppa Pig.
Ok if we are going to run with that very tenuous argument, how come there are animals walking around on two legs, wearing clothes, talking to each other? Clearly the lesson for kids is not biology, it's "people" (an analogy thereof in this instance) of the same "type" marry each other exclusively.
> you have differentiated class by accent
No, the show makers have. Either this was a deliberate decision or a mistake.
> but there's no harm in teaching about the royal family and our heritage
I might agree to that if the kids watching were British, but this show is widely exported, so in my case not my heritage (or thankfully my kids).
Maybe they could adopt (a panda bear, for example). Suggesting that marriage is related to reproduction is highly offensive to many people.
Let's dive in:
> Daddy pig is portrayed as an idiot
And yet he is loved by his family. He makes mistakes but also has many successes. It's probably his pride which is made fun of; he thinks of himself as amazing and perfect and yet makes mistakes, which are humorous in that context.
> All of the animals are married to animals of the same type
They sure are. I'm not sure why this is racist (but feel free to educate me at length). The target audience is two-year-olds, after all.
Come to think of it, I don't know that they're even married. Adult relationships aren't touched at all. Perhaps they're cohabiting but divorced due to London property prices.
> The only person in the show who seems to work, Mrs Rabbit,
Except for Daddy Pig, Mummy Pig, various workers at Daddy Pig's office, Mr Bull & friends, teachers, police etc etc.
"Friends" doesn't focus on the working lives of the main characters for the obvious reason that it's boring.
Mrs Rabbit doesn't seem exhausted (except as the explicit topic of one episode); it's more a Homer Simpson thing where it's funny that she does so many different jobs.
Accents are definitely racist though. Let Sarah Ann Kennedy know that she is a bad person.
> It heavily promotes the British royal family
It's a British show; why would you expect anything else?
Here's my gripe: animals never eat animals. It's always corn or carrots. Now, in a multi-racial society filled with animals of different needs, how does one get enough protein? I'm sure Mr. Bull has a little rabbit cage in his basement with a forced breeding program, his dark secret. We could explore it over the course of three episodes, as he is slowly outed and blackmailed by his friends. It culminates in an electric chair scene where he screams "Let's DIG UP THE ROOOOOAD!<zap>". Then everyone has meat for dinner.
I clearly said classist.
> It's a British show; why would you expect anything else?
I was expecting a childrens show, not a reinforcement of a world view that some people (royals) are better than others, just because they are born that way. So elitism. Not a positive message for kids, sorry if you disagree.
Glad you found my post funny though, you should look at some of the other articles online criticizing this show, and remember this is your child's psychology at a very impressionable age being influenced. As a parent, I don't find that funny I take it very seriously.
I agree that Peppa Pig is not a perfect show. I'll take it over Teletubbies (thanks again, Brits!) or Barney (thanks, USA!) But really, I'm not that concerned, because TV is not my primary means of educating my child.
Perhaps your child is different, but mine is indifferent to the subtleties of race/class/diversity politics. My child likes it when Daddy Pig falls down. He likes it when George goes fast in the racing car.
He doesn't know who the royals are and has no concept that maybe they're good and maybe they're bad and maybe it's theoretically unfair that people are treated differently by birth, but really isn't that a true statement anyway about life being unfair and pointless? Why should pigs get different treatment from dogs? Why can't cats dig up the road?
It is generally not a good idea to befriend a spider in Australia unless you know the exact species, even then it is generally best just to give them their space.
Miss Rabbit is a prime example of the perils of zero hours contracts, she's constantly having to find new jobs, and often trying to hold down multiple jobs at the same time.
Peppa and another show that I can’t remember the name but it is about “worms”. This other show is in Netflix Kids but it is very bad for childrens, has some very weird messages.
I am not banning it because it shows a lot of social interactions to the kids.
More research into the course of inappropriate use of primary care resources beyond Peppa Pig is indicated, perhaps combined with a dose of common sense, which unlike over-use of antibiotics does not have any known side-effects.
I think that does rather suggest that the article is not entirely serious...