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American NHS? Let’s call the whole thing off. By Matthew Norman

Blog | By Matthew Norman | Sep 04, 2023

For an institution widely believed to be on life support, the health service shows signs of vibrant health when it comes to inclusivity.

Take me, as the late Max Miller might have put it. Seldom does a month pass without the NHS – ‘our NHS’, technically, if only to Tory politicians with lavish private health insurance – graciously including me in one way or another.

Over the last couple of years, I have been such a regular at the Royal Free Hospital in north London that I anticipate the arrival of a loyalty card, entitling the bearer to free vinyl gloves and a two-for-one colonoscopy deal, any day.

In succession to impertinent inspections of the testes, kidneys and oesophagus, the latest act of inclusion concerns the heart. A 24-hour ECG having developed not necessarily to my advantage (an arrhythmia, cause as yet unknown), I was cordially invited for an echocardiogram. This procedure, for any medical ignoramuses, is an ultrasonic test to determine how well, or otherwise, blood is flowing to, through and from the organ.

The appointment was set for a morning a couple of weeks back, but the combination of a diary clash and the traditional FOFO (fear of finding out) dictated a postponement.

It was on my calling the cardiology department’s bespoke appointments phone line to rearrange that the extent of the NHS’s commitment to leaving no patient behind became plain.

If that notion seems bizarre in an age when nonagenarians can spend 18 refreshing hours nursing a broken hip on the street while awaiting an ambulance, consider the following.

On ringing the number, and being shocked to the precipice of ague on finding it unanswered by a human, I was treated to a recorded message. Among myriad options on offer was this: ‘Press the star button,’ the mechanical voice instructed, ‘for American English.’

So whenever next you hear of some tragic soul whose cancer metastasized (or rather metastasised, lest certain readers be perplexed) during the gaping temporal chasm between diagnosis and treatment, console yourself with this.

No one whose lingua franca is American English, but cannot speak a word of English English, will be let down by the Royal Free should they need to change an appointment.

Not, at least, if they have a heart condition. I cannot vouch for other departments. However, there’s no shred of evidence that these are any less accommodating towards this crucial linguistic sub-demographic of the unwell.

Should you ring gastroenterology, for example, and press the * button when prompted, there’s every chance of your hearing, ‘If during your consultation you are asked about the colour of your stools, please be reassured that the word “color” is brought to you without the letter u.’

As for orthopaedics, logic implies that pressing the button will bring forth ‘If you break a bone after falling on the sidewalk on the way to your appointment, don’t call us to cancel. Ring for an ambulance, and we’ll catch up with you in A&E when you arrive on Wednesday week.’

God knows what the * button leads to, American English-wise, in cardiology. It might be the simple substitution of ECG with EKG, or something less technical such as ‘If you think two flights of stairs

‘If you think two flights of stairs could

kill you, please take the elevator instead’

could kill you – and with your heart, you might just be right – please take the elevator instead.’

It may even be something more playful, such as ‘If your appointment is scheduled for 2pm, please arrive 15 minutes early at ... but, hey, you do the math.’

With hindsight, I suppose I should have pressed the * button, and found out. But news of this option’s existence induced such instant, violent palpitations that I feared another ounce of high excitement would provoke a myocardial infarction – and that on a day when my defibrillator paddles happened to be at the dry cleaners.

Reflecting on the matter now, I do find it extraordinary that this group is so abysmally ignored. We hear much about the exclusion of vulnerable minorities, but never a dickie bird about the battalions of American-English-speakers in grave peril of dying of thirst because no one has informed them that what they call a faucet is known here as a tap.

George Bernard Shaw was no dummy in the medical field. The Doctor’s Dilemma, a magnificent play, now reads less like a brutal satirical deconstruction of early-20th-century class-based health inequality than as an eerily prescient vision of what ‘our NHS’ would become.

But the old boy dropped something of a bollock when he famously described England and America as two countries divided by a common language. English English and American English have nothing in common whatever.

If you don’t believe me about that, check out the hordes of ailing tourists from Baltimore and Phoenix who are wandering endlessly around the ground floor of the Royal Free, desperately trying to get their prescriptions filled.

They are wholly unable to compute that the area with ‘Pharmacy’ above its entrance – the one with all the medicines prominently displayed on shelves – is in fact the drug store.