Health Care

Well, it’s been a few months now and I have had a lot of you asking me about how my job is going and how the health care in the UK compares with that of the US.  I recognize that this topic may be more interesting for those of you who work in health care, but I thought I would write it anyway.

National Health Service...my employer.

As most of you know, health care is a topic that I could talk about for hours, which mostly results in the glazing over of eyes after a few minutes (at least that’s how long Katie lasts). The fact it, it’s a conversation that I very much look forward to having with people but I believe that it should be just that…a conversation.  There are a number of things that I really miss about health care in the States and there are a number of things that I am truly enjoying about my job here.  That being said, it’s important to remember that there is a very big difference between being an employee working in a health care system and being a patient receiving the care that system provides.

What I do know is that this experience is giving me a very unique perspective on how different health care systems can work and it’s helping me to construct a viewpoint on what it means to have “quality” health care.  The honest answer is that although I am seeing a lot of differences, even I don’t know exactly where I stand on the issue. As a result, I will save opinions for our future conversations and instead try to present the facts and observations that I have found most interesting.

Initially, pronunciation of medical terminology was difficult to adjust to.  Obviously we all have the same anatomy and every hospital in the world has pretty much the same departments, but what they call them is a different story.  For example here “respiratory” is pronounced “res-PEER-i-tree” and “trachea” is pronounced “tray-KEE-ah.”  Physical Therapy is Physio Therapy and the only people who you call “Doctor” are the GP’s (General Practitioners) and the L1 and L2 junior doctors (like 1^st and 2^nd year residents).  Once a doctor becomes a surgeon and/or has completed enough procedures to reach “consultant” status (like an Attending in the US), they are then referred to as “Mr” or “Miss” and no longer “Dr.” This was really hard to get used to since most of the people I work with are consultant ENT surgeons who are VERY experienced.  So, I needed to quickly learn to call him/her “Mr. Wilde” instead of “Dr. Wilde” because the latter would technically be insulting. 

I never thought these words would ever come out of my mouth, but “I have a whole new respect for paperwork.”  This was one of the least favorite parts of my job in the States and I’m not saying that I enjoy it here, but never has the importance of consistent and clear documentation been more evident.  The thing I miss most about the US is the fact that everything is done on the computer.  The NHS is just now starting that painful transition to computerized documentation that a lot of us went through about 4-5 years ago, but for the time being, we are still using paper charts and all the scheduling of patients is done by the therapist by hand writing in my diary (oh yeah, here your scheduler book is called your “diary.”)  Every time I schedule a patient, I resist the urge to write “Dear Diary” at the top of the page. : )

There are a few things that I really don’t miss about working in the US health care system.  In the three months I have been working here the word “productivity” has never been used.  In the US, I was used to every second of my time being accounted for.  You were met each day to a full schedule of patients and you were lucky if you got time for lunch or paperwork.  Now, I’m not saying that I haven’t been extremely busy here and we certainly need to be productive, but there isn’t a predetermined target for how many hours you need to “bill” each day.  Instead the most important thing is that you do a good job with patients and represent the Speech service well throughout the hospital.  As a result you have fewer patients on your schedule each day and get to spend as much time as you want seeing them. This also allows you extra time to do the little things like make follow-up calls to check on patients and work on program development aspects of your job.

Entrance to my building

I do have to say that so far my absolute favorite thing about working here is how incredibly collaborative the care is.  In the US, sometimes the hierarchy of doctors, nurses, and allied health can very clearly defined, and as a result it can create a sense of division between care providers that can negatively impact how cohesively a “team” provides care.  There just doesn’t seem to be that here and there is just a culture of everyone being on the same level, each approaching the patient with a different specialty to provide the best care possible.  One good example is our Joint Head and Neck Cancer clinic every Tuesday afternoon.  In this clinic the entire head and neck team is present which includes 3 ENT consultants, 2 surgeons, 2 oncologists, 1 clinical nurse specialists, and the cancer specialist for nutrition and speech and language therapy (me).  It’s an open clinic where patients have a chance to see the entire team at one time and the entire team is able to establish a comprehensive and collaborative plan.  This kind of service delivery model would NEVER fly in the US because insurance companies would never pay for it.  They would say that everyone was providing too similar a service to justify covering all the care provided.  If you are a US hospital, know that this is SO incredibly efficient and great for patient care, but your hands are tied by the payment regulations of the insurance companies.  If you work in health care you exactly what I am talking about : )  Anyway, since the health care here is paid for from the same place (the National Health Service) it’s much easier to set up these type of patient-centered clinics.  This type of efficiency is not only encouraged but expected and ends up saving the hospital money AND benefiting the patient. 

Prime Minister David Cameron and his wife
after having their baby at the Royal Cornwall
Hospital.

Lastly, I am finding that the pace of the workday is much different here.  It is quite common for all of us to arrive in the morning, sit around and have a cup of tea for awhile and then go up to see our patients.  Almost everyday about mid-afternoon everyone will also take another break to have some more tea and relax before finishing up for the day.  Since my job is a leadership position it’s a little bit different than the rest of the speech team.  As a result, I spend a lot of time in meetings and working on program development, policies, procedures, etc.  This has definitely been an adjustment from being in a strictly patient-care role back in the States, but I am finding that I really like it.  I am the only specialist in Head and Neck Oncology here, which means that my role is to see these patients almost exclusively. I was excited to find that it is expected that I attend the monthly laryngectomy club and cancer recovery club meetings, which are organized and led by cancer survivors for newly diagnosed patients.  Considering that these meetings take place during the workday at a local pub, I can’t really complain about getting paid to attend. Other than that, I have also been filling a dysphagia specialist role and am in the process of rolling out the FEES service here, which this hospital has never had.  It’s been a great challenge and I feel like I am getting some really diverse experience, which is exactly what I was hoping for.  I find there are some opportunities for improvement within the speech service here and the challenge of being responsible for changing these things is something I am enjoying more than I thought I would.

Overall there continue to be many aspects of my job here I love and many things that I miss about working in the US.  I suspect that this will remain the case throughout the next year so I am just trying to keep an open mind and learn as much as I can from this opportunity to just do something different. 

At the end of the day, whether we want to or not, we will ALL be a patient receiving health care at some point in our lives.  I think no matter where you live in the world, the quality of care you receive is more dependent upon the actual person providing that care than the system in which that person works.  Working with health care providers who genuinely care about their patients and go out of their way to provide the best care possible is probably the biggest similarity I have seen between my colleagues in the States and my new colleagues here.  If there is one thing I find that holds true no matter where I work, it’s that the best doctors, nurses and therapists are the ones who never forget that they will one day themselves be the patient.