The Canes of York

After the sojourn at the Jorvik Centre, which I wrote about in last month’s column, we were off to the York Minster following a route where the traffic sounds differently than it does in the United States. The air fills with the grind and rumble of diesel engines, and the rush of doubledecker buses gives a great thump.

My mind overflowing with images of arthritic skeletons, I peered at the people to detect the imprint of either the NHS or their Viking ancestors. In front of Bettys Tea Room, I had eureka moment about the difference between the people of York and those in the United States. The difference turned out to be the number of people walking with canes.

In life, once a relationship becomes clear, it is surprising how it was previously missed. Suddenly everywhere I looked, I saw older (and not so older) people walking with canes. Some had walking sticks, some had dark wooden canes, and some had shiny metal ones. Many a hand with Herberden’s nodes was gripping a handle as people wobbled and limped.

Impromptu Research

I decided then to do some quantitation. Standing on a street called Spurriergate, I took a convenience sample of cane usage. Convenience samples are prone to spurious results, but I was on vacation and unable to do anything more elaborate. In 30 minutes, ignoring those with umbrellas used as aids, I counted 14 people with canes, four in wheelchairs (two motorized, two pushed), three people with crutches, and one person with a wand. The one with a wand was a cute little kid dressed as Harry Potter and on his way to the movies.

Satisfied that more people in England used canes than back home, the immediate question was why. Did it have anything to do with the difference in the healthcare system, on the one hand, and the people, on the other hand? The Brits are known for their high frequency of arthritis. The weather, of course, could make anyone twisted and gnarled.

My first thought was that the profusion of canes resulted from the often-discussed delay in joint surgery that occurs in the NHS. People in Britain who need joint replacement supposedly queue up and wait two or three years before for their operation. To critics of the NHS, the delay in joint replacement is a poster child for the system’s shortcomings. With the path to the operating room slowed or blocked, those with arthritis would have to make do with assistive devices and painkillers to get around. In this scenario, canes would be the red flags for NHS backlogs.

You don’t have to be an epidemiologist to know that other explanations could account for my observations. These include a greater willingness of the British to use canes; a desire to walk outside despite pain or disability; or even a reluctance to undergo surgery that would make an American run for the knife. A more worrisome explanation is that the people with canes had already had their joint operations and the NHS surgeons are not the best.