Updates on tea and medical bureaucracy

I get some fantastic comments on this blog and a few of them just have to break out of the comment section. So I’m going to pick up on four of them, two about tea and two about medical bureaucracy.


If you’re American, you think I already wrote more about tea than is either intellectually or physically possible. But I live in Britain. Tea is the binding force that holds the nation together, and let me tell you it’s looking a little shaky lately, what with Scotland having held a referendum on whether to leave the union and, far more shockingly, so many kids these days getting their caffeine from energy drinks instead of a respectable source like tea. Not to mention the number of tea drinkers allowing themselves to be seduced by fancy coffee and if that isn’t enough the possibility that Scotland will hold another referendum in the (less than immediate) future.

Screamingly irrelevant photo: fall berries. I'm not even sure what they are.

Screamingly irrelevant photo: Fall berries. I’m not sure what they are but I don’t recommend tasting them.

And I’m not sure how the Welsh feel about referendums and secession. Or even whether some purist is going to tell me that the plural is referenda.

So, yeah. We need our tea. And we need to make it right. Which brings me to the point—and yes, there is one. Or two actually. You only had to wait.

J. tells me (and this was in person, not in a blog comment, which is why she’s going by an initial; the tradition may be silly but at least I’m consistent) that I ignored the role of teapots in my last tea post. Sure, I mentioned them, but you can’t make a nice cup of tea, J. says, unless you make it in a pot. Actually, she probably said “a proper cup of tea,” but I was listening to the sense, not the words, sadly. The sense was this: Make it in a cup and it just doesn’t come out right. Even if you only make a single cup, you need to make it in the pot and then pour it into the cup.

Why? Because it’s not a proper cup of tea otherwise, and if it’s not a proper cup of tea it’s not a nice cup of tea. And if it’s not a nice cup of tea, Scotland might just spin out into the North Sea, leaving the northern edge of England a ragged tear (pronounced tare; people may or may not weep about this, but it’s not what we’re talking about) across the land.

That’s not intended, by the way, as a comment on whether Scottish independence is a good idea. I could argue both sides of the proposition with equal passion. But the spinning into the North Sea? That’s just, you know, a fact.

Oh, and the pot has to be warm. Because the tea will brew better.

J.’s of the bone china school of tea drinking. Because it tastes better that way. It doesn’t have to be a fussy little cup and saucer—a mug’s fine—but for her it has to be made of china. Me? I like a heavier mug, but I try not to argue religion with friends.

So that’s one point. And then in the comment section, helenwood wrote about a job she had long ago, working for a tea importer, pouring water over the leaves so the tasters could sip and spit. But that wasn’t what grossed her out—it was that the tea leaves scattered on the warehouse floor, and presumably walked through by one and all, ended up in teabags.

If anything’s going to convert me to leaf tea, that would do it.

Medical bureaucracies

Moving on, then, from a serious topic to the trivia of our lives, we come to what I wrote about medicine in the U.K.

Ianbcross, a doctor who’s worked in the National Health System, commented that the Choose and Book system gives patients a code so they can make an appointment with a specialist online or by phone. “If there are no appointments available,” he writes, “it is up to the hospital to find one for you. You decide whether to accept it or not. This is for routine stuff. If your doc thinks you might have cancer, you get a two week wait appointment from the hospital. Less choice for you, but as soon as they can, they fit you in. Emergencies go directly to hospital, without passing GO, of course.”

Well, this is a guy who knows the system, and his comment made me wonder if I’d misremembered my experiences and Wild Thing’s. So I did what any sane blogger would do: I took a small and unscientific survey (I’ve stolen that phrase; it’s nice, isn’t it?) and came up with the following revelation: Our local surgery (that’s a doctor’s office if you’re American) is all set up so you can use the Click and Book system, but they don’t tell you about it. If you ask to use it, they’re happy to let you use it. But if you don’t already know about it, you can’t ask. So you sit around waiting for that letter.

Unless—as happened to me recently—you get a phone call. From the wrong hospital. But never mind, it was a phone call and it came quickly.

When I acted as an advocate for our neighbor, it wasn’t about getting an appointment but about shaking loose the report from an appointment she’d already had so she could (a) find out what was wrong and (b) do something about it. The doctor had dictated the letter and there it sat, waiting to be typed. And as far as I could tell there it was going to sit and wait until pine trees grew in hell.

The practice manager and I had a leave-it-with-me conversation, and I left it with her until the end of the day, when I called back. Which reminds me to mention that the NHS has a wonderful service called PALS, which stands for Patient Advocacy SomethingWithAnL SomethingWithAnS, not (as it did when I was a kid in New York) the Police Athletic League. I called PALS just after I talked with the practice manager. I suspect it’s owed the credit for getting that letter in the mail. I heard a rumor the service’s funding is going to be cut. I hope it’s not true, because the idea that within an inevitably bureaucratic system are people whose job is to make a nuisance of themselves when things aren’t working for the patient? That’s inspired.

In another comment, Dan Antion reminded me that in the U.S. the first questions anyone medical asks are about your coverage. If you’re not American, you may need that translated: Do you have insurance? Who’s your provider? What plan are you on (secondary translation: does your insurance plan cover this procedure)? And so on. In other words, everyone talks money while you bleed onto the floor, because money is what matters. (Note to the current U.K. government: Are you sure you don’t want to rethink that whole privatization of the NHS thing?)

And if anyone in Britain thinks it’s just the NHS that has unacceptable delays, he tells the story of a friend with a life-threatening condition who needed surgery and was told she couldn’t be seen for six to eight weeks.

The thing about the NHS is that until the current round of disorganizations were introduced, it’s been a unified system, so people talk about unacceptable delays, and newspapers write about them, and word generally gets passed around and everyone’s outraged and wants something done about it, which creates pressure to actually do something. When emergency rooms keep people waiting for more than four hours, it’s considered unacceptable. In the U.S., my father was left waiting in the emergency room for, if I remember right, seventeen hours. With meningitis. At the age of ninety. And he had good insurance. We were furious, but it was business as usual and didn’t tarnish the hospital’s reputation, or the U.S. medical system’s.

An update on political absurdity

This British American Life has a funnier example of American political absurdity than the one I sent out a little while ago. Follow the link to learn about the paperwork you have to submit if you want to be reimbursed for going to the moon. Because you can never tell when you might need to know that.

And while we’re talking about absurdity, don’t you just love that I provided a link back to my own post, even though I said wasn’t as funny? Anybody want to place bets on how many people will follow it?

Going postal in the U.S and Britain

In my unending efforts to compare Britain and the U.S., I helped out with a bulk mailing on Tuesday night. Bulk mailing is an American term meaning “damn, we have a lot of paper here.” I’m not sure how you say that in British.

Back in Minnesota, I was the entire staff of a very small writers magazine, and in the early years part of my job was to gather a crew of volunteers and mail the thing. Because it was cheaper to do a bulk mailing, we did a bulk mailing. (Hey, we were a  nonprofit. Money was tight.) This involved crawling around the floor, attaching address labels, and sorting everything according to zip code, and it was this last bit, the sorting, where we’d get into trouble. Every month, I introduced new volunteers to the post office’s bulk mail regulations in tooth-shattering detail, but I never found the right words to make it all clear. That was because what we had to do ran off the edge of the English language.

A footpath in Cornwall, with wildflowers.

Irrelevant photo: The primrose path. Really. These are wild primroses growing along Lover’s Walk. I don’t think the flowers are why the path got that name. Lover’s Walk is one of the few paths in the parish where a couple stood any chance of finding a little privacy.

It was something like this: If we had more than ten addresses in a single zip code, we’d band them together. If we have less, we’d combine it with others in nearby zip codes according to some complicated system I barely understood at the time and can’t come close to remembering now. Even if did remember, though, it ran off the edge of the English language so no explanation would help. Then we’d label the bundles and combine them in some equally obscure and incomprehensible way and dump them in canvas sacks, which again had to be labeled before we hauled them down the stairs and threw them in the back of my car.

That last bit? The one that involved heavy lifting? That was the easy part.

Then I delivered the sacks to the loading dock of the main post office and waited for the phone to ring, which it often did a day or three later. It would be someone from the post office would tell me to come back down, pull the sacks out of the canvas wheelie things they’d been thrown in, and fix the mailing in some obscure way I barely understood at the time and don’t understand at all now.

Remember those new volunteers I said I had trouble explaining the system to? Well, none of this was their fault. If ever there was a system calculated to help me screw up, the U.S. Post Office had found it.

Eventually the organization I worked for paid another organization to do the mailing. Whether that was for efficiency or mercy, I don’t honestly care. I’m still grateful, and the Minneapolis Post Office held a three-day celebration. No mail was delivered until the hangovers wore off.

And now here I am on British soil, and by one of the universe’s little ironies, I was the one who organized last Tuesday night’s mailing. The Truro Post Office is hiring crisis counselors already and we haven’t even delivered the boxes.

What we were mailing was called an election address (anyone but a post office would call it a leaflet) from a parliamentary candidate who has about as much chance of winning the election as I do of following complex instructions from the post office. Any post office. The candidate’s not running to win, although I’m sure he wouldn’t mind if he did, but to raise awareness of the way the National Health Service is being chopped up and privatized and underfunded. I won’t go off into a political rant here, and if you disagree, that’s fine, because the political bit ends here. The point is, even though he’s not running in our district, six friends and I thought it was important enough that we gathered to help out, together with one chocolate cake (which had no opinions on the subject and didn’t survive the night), many rubber bands, five or six kitchen scales, and an awful lot of paper.

Parliamentary candidates in England (and I assume the rest of Britain) have the right to mail one, ahem, election address to everyone in their constituency (which I’d call a district, but I’m not in the U.S. now, so constituency it is). These don’t have to be individually addressed, mercifully, or we’d still be there, pasting and sorting and gashing our teeth. And probably, by now, throwing chocolate cake.

But addressed or not, a post office is a post office, and it has its regulations. The leaflets had to be sorted into bundles of a hundred and banded. We could use either one rubber band on these or two. My instructions didn’t say what would happen if someone used three, but none of us was brave enough to try. Every last leaflet in the bundle had to face the same way. We weren’t sure if the bundles all had to be placed in the boxes facing the same way, so we made sure they did.

We had 24,000 leaflets to mail, which I kept calling 2,400 and, occasionally, 44,000, which helps explain why I shouldn’t be allowed out in public but doesn’t explain why anyone let me to stay in the room while numbers were in use. Rather than count all 24,000 (or 2,400, or 44,000) sheet by sheet, the campaign office had told us to count a few initial bundles and weigh them, and that’s what the scales were for. A hundred leaflets weighed 792 grams. Except when they weighed 790 or 798, because kitchen scales aren’t as accurate as the digital displays make them look like they are. Or except when I’d drift into my dys-whatever-it-is that people allergic to numbers have, and I’d weigh out 992 grams and a few minutes later someone would ask why one of the bundles was so thick and reweigh it.

Then the bundles had to go into boxes, all facing the same way, thanks, and each box had to have a printed label that included a blank spot for the number of leaflets inside. For the sake of our sanity, we put the same number of bundles in each box—twelve.

Do you have any idea how hard it is to count to twelve?

Never mind. We finished in time to eat the cake and all get home by ten. The boxes have to be dropped off on Friday—the day I’m posting this—at a tightly scheduled time, and the person dropping them off has to wear a hi-vis jacket and safety shoes. If male, he has to part his hair on the right and wear black-framed glasses; if female, she must not have used hair spray for two days prior to appearing at the post office and should wear contact lenses.

I’m waiting for the post office to call me down to Truro so I can fix whatever I screwed up. A bundle deep inside one of those boxes has 98 leaflets. Or 102. I’ll have to unband and count them all to find out which one it is.

The post office doesn’t have my phone number, but it’ll find me anyway. Some things that you do in life will follow you, no matter where you hide.

True Confessions: I Misread My Tax Disc

The is a P.S. to my last post, which was on bureaucracy and trying to pay the tax on my car. Just after I posted it, I gathered up every vaguely relevant piece of paper I could get my paws on and presented myself at the post office, hoping to convince an actual human being that my car was real.

For anyone who doesn’t live in the U.K., I should explain: The post office isn’t just a post office. And it’s capitalized—the Post Office. Sorry. I’m just a lower-case sort of person. The Post Office is also a bank and a place to pay some of your bills and some of your taxes. In a village, it’s not a bad place to get gossip, two onions, and a container of milk, because it’s also a small store. So going to the Post Office wasn’t a measure of how far around the bend I’d gone but (at least in my mind) a clever attempt to outwit computerized insanity.

But I had to go to a larger, non-onion, non-gossip Post Office, because our local sub-Post Office can’t handle car taxes anymore. I’m sure that makes sense to someone and I doubt it would to me if they explained it.

Irrelevant Photo: The Cornish Coast

Irrelevant Photo: The Cornish Coast

I talked with a very nice woman, who scanned my eleven-digit number, told me—with just the slightest air of panic, as if I might get dangerous any moment—that she didn’t need the rest of the papers I was toting, and began the process of registering my car.

I’d promised myself that I wouldn’t tell her the tale about how the computer wouldn’t recognize my car, but it took less than a minute before the words were out of my mouth. You know how that works. I know you do. She didn’t refuse to go any further, though. She laughed. Maybe that was the point where she decided I was safe to have around.

Or at least entertaining. There was no one on line behind me.

She called someone else over, and they looked at the screen together.

“When does your tax run out?” she asked.

“On the twelfth.”

I’ll summarize, because the conversation was long and I don’t remember most of it anyway: Car taxes can’t run out on the twelfth. They run out at the end of the month. Any month. Whatever month. If I saw a twelve on the disc, it must run out in December.

I was fairly sure it didn’t, but—in that strange way that you can believe two opposing things at once—I also believed it must. Otherwise how did twelve come into the conversation?

Have I mentioned that there’s nothing involving numbers that I can’t screw up?

I could, she told me, go ahead and pay the tax, but if there was an overlap I’d be paying double for those months. For a fleeting moment, the idea appealed to me. It would be done. Even if I paid double for eleven months, I wouldn’t have to think about it again until—well, whatever September plus eleven comes to.

Or twelve. Wouldn’t that be twelve?

I asked her something—I can’t remember what—that she could only answer if the second person came back from doing whatever he was doing, which involved another window, Canadian dollars, U.S. dollars, and time.

We waited. She looked at her screen. A line was building up behind me.

“It’s not showing up as expired,” she said.

I think she told me that in a couple of different ways before I understood: At the very least, the car’s okay until the end of this month. It hasn’t expired. It can’t expire on the twelfth.

“They’ll send you a letter,” she said.

“They still do that?”

She said they do. I’m not sure I believe her, but it would be very sensible if she turned out to be right.

“Why don’t I wait, then?” I said.

She handed me back the one bit of paper she’d actually needed and I moved aside to fit it back into my folder, thanking her as I went. Recalcitrant bits of paper were trying to escape and make their way back to her window, but I wrestled them down, then turned to everyone still in line and apologized for holding them up. It was—for reasons I can’t define—a very un-British moment and I had an odd glimpse of myself as a street entertainer. I had to stop myself from taking a bow.

No one had yet moved up to the window I’d vacated. They were waiting.

“Can I help who’s next?” she said.

I finally got to my car and looked at my tax disc. They’d shown me how to read it, so it almost made sense this time. It expires at the end of September. There isn’t a twelve to be seen.

Bureaucracy, U.K. Style vs. U.S. Style

I do love bureaucracy. Wild Thing swears that customer service in general and web sites in particular are worse in the U.K. than in the U.S., but I’m not sure she’s right. If anyone wants to weigh in with an opinion, I’d love to hear it.

My senior rail card runs out in not so many days, and I’ve been trying to renew it. Online. On the phone. By intense psychic messages. Quick, because if I can’t get this done before it expires I have to drive 40 minutes to renew it in person by presenting proof of my existence, my age, and my warm feelings toward Network Rail.

I begin online. I still believe this will be easy, and I answer their questions.

Password? I get that on the second try.

Renew? Yes.

One year? Three years? A thousand years? Oh, a thousand. Think of the discount.


Irrelevant Photo: Boat. Photo by Ida Swearingen

Irrelevant Photo: Boat. By Ida Swearingen

“We save your details at every step,” the second or third page chirps at me. “Just log back in to pick up where you left off.”

It doesn’t tell me this, but I’ll damn well need to pick up where I left off because I won’t be able to finish on this visit. I’ll be coming back and picking up where I left off until I’m so old I qualify for a SuperSenior Rail Card. Which doesn’t exist yet. They’ll introduce it just for me.

But I don’t know that yet. In all innocence, I move to the next page, fill in my credit card details, and hit the Irretrievable Commitment button. The internet takes a few moments to contemplate the obesity of the universe and comes back with a message saying my card’s been rejected.

Well, that card’s difficult. Sometimes I want to buy things that the issuing bank doesn’t think I need. It’s the strict parent. But I have another card—the indulgent parent—and I enter that one.

It won’t take that either.

I call and we go through all the same details. When we run out of details, the guy I’m talking to says their payment system’s down. But he can give me a number so we can pick up right where we left off.

He couldn’t tell me this at the beginning of the call?

I write the number down on a shred of paper in the morass I call a desk. I keep a pad on the desk—for all I know, I keep several—but it sank to the bottom months ago, so a shred will have to do. He tells me to call back in an hour.

But I’m no longer the sugar-fed fooI I was at the beginning of the process. I wait a full day, then go back to the web site. Most of my information really is still there. I fill in what’s missing and hit Buy Rail Card.

I get a message saying I already have one. I don’t, but there’s no one to argue with and I’m locked out of the payment page.

I call and, in a rare moment of good organization, find my transaction number and read it out. Just to confirm that I am who I say I am, the man I’m talking asks for my name, my address, my date of birth, and everything the first guy asked. But it’s okay because we’re saving time here and it’s much more convenient.

Then he tells me the payment system’s down—either again or still, I don’t have the heart to ask which. I can call back in 45 minutes.

I wait another day and try the computer. When I get to the message saying I already have a Senior Rail Card, it suddenly hits me that maybe I really do. Maybe my transaction of two days ago went through. Maybe my transaction from two days ago went through twice, once on each card. I may now have two rail cards. I may have to prove I’m over 120. This worries me, as does the possibility of being charged twice for my, ahem, discount card.

I don’t call. I’ve lost the magic number that saved me eons of time, besides which I lack the moral fortitude. Besides, I may really have a rail card so I should wait to see if it comes in the mail.

The next morning, for a change of pace, I go online to renew the tax disc on my car. In the past, we’ve been able to do this at the post office, but come October this has to be done online and we won’t get an actual physical disc to put in the car windshield, it’ll all be tracked by computer, because computes are infallible. If we fail to register our cars, we’ll be fined £1,000 pounds and hung by the neck until very, very sorry.

It’s not October yet, so I could still go to the post office, but as far as I understand it—which is not very far—I’ll have to register online by October anyway, so why not get it all done at once?

Under the old system, every car owner has gotten a reminder letter, but to save money in this age of budget cuts these are being stopped, and the only warning has been a bare few back-page newspaper articles and whatever gossip we’re lucky enough to pick up. And the newspaper articles weren’t all that helpful. Exactly what were we supposed to do and how? They didn’t say. They probably don’t understand it either. But we are all going to be in a lot of trouble if we don’t do it. In other words, the new system is being introduced with all the competence I’ve come to expect of the current government.

Just the day before, I asked at our repair shop, figuring, you know, cars, registration, they’d know this stuff. They hadn’t a clue and of the two women at the counter, one’s registration was about to run out and she was catching that first panicky whiff of trouble herself. It smelled like the burning-rubber-on-the-highway scent that tells you your car’s about to do something unfriendly, like catch fire maybe.

So they couldn’t help me. I can count only on myself this sunny morning. After googling several wrong terms, I find the right section of the right department of the right government website and I enter the eleven digit number from my log book.

The web site would have also accepted a different number, I think it was thirteen digits, from the letter they didn’t send me, but since they didn’t send it this year—well, just because they didn’t send it doesn’t mean they have to stop asking, does it?

I entered my information. The website reported that my car doesn’t exist. But it’s okay, because they have a phone number.

I dial. The system is automated and I punch in my eleven-digit number. I’m told that my car doesn’t exist but that I may have punched the numbers in wrong. I didn’t, but there’s nothing involving numbers that I can’t screw up, so I try again, checking each digit as I add it. Nope. I try a third time. At the end, surely  they’ll have pity and let me talk to a human being. But in these days of budget cuts, human beings are like my car: They don’t exist. I’m no longer the system’s problem. Goodbye. I have a non-existent car. I have a tax disc that’s about to go out of date. I have a phone and a computer and neither of them will do me any good.

The Department of Non-Existent Car Registration is going to hang me by the neck until very, very sorry.

Your honor, I’m already sorry. Very extremely sorry. And I have a magic number, somewhere, from Network Rail. Couldn’t I read that out and save us all some time and trouble?

I need a break, and since the letter carrier’s come and gone without bringing my imaginary rail card, I dial the rail card line. I wait for it to ring and go blank about what I’m trying to renew. I gaze at the shreds of paper on my desk. Call Simon, one says. Write Emily piece, another advises.

I understand these, but I still can’t remember who I’m calling.

An automated voice says something about rail cards. Yes! Rail cards! I need a rail card! I punch 5 without waiting to hear my choices. That’s how well I know rail cards. A man answers and I ask if the payment system’s working.

“As far as I know,” he says.

I’d kind of hoped for a yes, but I read out my magic number, which has resurfaced, and he asks for my name, my address, my date of birth. We save more and more time. I give him my credit card number. He tells me my card will arrive in three to five days. By which time I may have found a way to convince someone that my car’s real. Or that I don’t have a neck and am therefore exempt from punishment.

Tomorrow I have to do something about my U.S. voter registration. I sent the form in, but I just checked online and I’m not listed.