We feel it is important that you are aware of all of the costs which may arise from this consultation, even if you have medical insurance, because sometimes insurance providers ask policy holders to pay for some aspects of their care. Further investigations are invariably needed to support a clinical opinion. The costs of some of the most commonly used investigations are given below, along with some brief explanation of what may be necessary and why.
For those who are insured, Dr Dakin is presently fee-assured, so there will be no additional consultation fees for those whose insurers pay only a standard rate. Medical insurance companies often (but not always) cover payment of tests done on the day of the consultation but we would recommend that you check with your insurer.
If you are funding your own consultation and treatment (without insurance) then sometimes GP’s are prepared to arrange the blood tests which may arise, if they feel that these tests would have been needed anyway.
Likewise, in the event that any treatment is recommended, Dr Dakin can either issue a private prescription, or ask your GP to consider prescribing on the NHS. Some insurers are prepared to cover the cost of a private prescription if issued at a specialist consultation, though others are not. Quite understandably, some GP’s are not prepared to action prescriptions or blood tests which originate from a private consultation.
Spirometry will be needed for most patients. This test measures the volume of the lungs and the airflow during inspiration and expiration. This test gives a general indication of the health of the lungs and airways. Spirometry may be particularly useful for anyone with suspected asthma, COPD, bronchitis, emphysema, shortness of breath, cough and lung nodules amongst other conditions.
Exhaled nitric oxide (FENO) may be measured in anyone with known or suspected asthma. Nitric oxide is produced in larger quantities in those with asthma, making it a useful marker for this condition. Undiagnosed asthma is a frequent cause of unexplained coughing and / or shortness of breath.
Full lung function testing includes spirometry (as above) but also additional tests which measure the ability of the lungs to transfer oxygen to the bloodstream. Full lung function is arranged privately at the Royal Surrey if needed.
Xrays and imaging
A chest xray is needed for almost all patients, as it gives an overall picture of the lungs and heart. Dr Dakin always prefers to view any radiological imaging himself, rather than relying upon a written report which is issued with an xray from another hospital.
If you have already undergone an xray within the last couple of weeks, it may not be necessary to repeat the examination, as long as we are able to arrange transfer of the image to the Nuffield. However, most NHS hospitals are not prepared to send images to other hospitals without signed permission from the patient, and payment of a small fee in person at the NHS hospital cashier’s office. That said, Dr Dakin also works at the Royal Surrey Hospital, so is able to view any xrays taken at the Royal Surrey Hospital, without the need to arrange transfer.
If the most recent chest xray was abnormal in any way, then it is often helpful to obtain a repeat xray, as many abnormalities such as infection clear after a month, so that no further action / investigations may be necessary. Likewise, for those with a long-term condition it is helpful to repeat the xray from time to time to detect any change.
We usually anticipate the need for a chest xray from the referral letter, so that it may be arranged prior to your appointment.
CT scans are like xrays but give a much greater level of detail. A CT scan is performed whilst a subject lies on a table within the scanner. The scanning environment is spacious and airy and is not problematic for those with claustrophobia (unlike MRI scans). An injection of iodine may be given during the scan to show up certain tissues and blood vessels to advantage.
Blood tests are often needed, to check on various aspects of your respiratory and wider health. The full blood count looks at all of the different kinds of cell within your blood, and may detect anaemia; the neutrophil count may indicate infection and the eosinophil count gives an indication of activity of asthma. A full blood count is needed for most patients. Immunoglobulins (IgA, IgE, IgG, IgM) are special proteins within the blood, involved in immunity and allergy.
In most cases it will be necessary to have a chest xray, one or two blowing tests and several blood tests (eg full blood count, IgE).