Healthcare: a commodity, a luxury or both?

I expected my biggest culture shock between the USA and the UK to be healthcare.  I was determined to be open minded about American healthcare because it is all too easy when you grow up on a diet of free healthcare to think everything else is wrong.  On the face of it, the two systems couldn't be more different.  In the UK, the NHS means you can rock up to any hospital and get free treatment.  In the USA, if you want healthcare, you've got to pay for it; so basically able to afford insurance or somehow able to pay massive hospital bills.  That's putting it simply, of course.

A train view of the Big Apple

So what are hospitals and healthcare like in the US of A?  (Caveat: I am very much an observer here, having no clinical role.)  There are some more overt differences - the doctors wear white lab coats with their names embroidered, something we stopped doing in the UK when I started medical school 8 years ago.  I always carry my health insurance details on me.  Despite insurance, I would still have to pay a 'nominal' fee of between $25-75 (roughly £18-60) if I needed to see a doctor.  Teeth and eyes are extra. The hospital in my area is incredible.  There are trees inside one of the lobbies.  INSIDE.  At the clinical meetings (where doctors and researchers sit and listen to an expert giving a talk), you might have coffee and something to eat (and no pharma in sight). These meetings are always full, and always interesting.  I can only praise the close supervision and guidance I have been afforded by my research team (one of whom is a clinician, and one soon will be).  There is passion for good, compassionate patient care and research that will save lives.  There certainly is not a sense that everyone is rolling in money, and research funding is as squeezed here as it is everywhere.

Now, of course, the real problem does not lie inside the hospital.  A walk around town tells you all you need to know about who is, and who is not, benefiting from this phenomenal healthcare.  It is painful to witness the huge divide between those who can and cannot afford not just healthcare, but basic living.  To me, it feels like a bigger divide than home.  Uncomfortably big.

And yet, I do find myself thinking that the NHS can learn something from American healthcare.  Whilst it may seem like a waste of money to be giving food and drink to staff for free during a talk, it does make you feel like what you are attending is worthwhile, that you are valued and frankly means you can actually eat something whilst being productive.  Now, I'm not saying I'm expecting freebie food and drink in a publicly funded healthcare system.  I'm just pointing it out in a week when this story came out about a hospital in the UK that has banned staff from drinking tea or coffee at work, and UK junior doctor contract negotiations have stalled for a range of reasons which made my heart sink to the floor (take a read. It makes for fairly sobering reading).  When I worked in one department as a newly qualified doctor 18 months ago, we used to take it in turns between the doctors and nurses to buy a round of 'fancy coffee' (read: from the coffee shop rather than the machine) if the day was especially horrific.  I maintain it was the most efficient use of a tenner for team morale that I could wish for (and out of our own pockets, of course).  Sometimes these things are actually value-added rather than a silly luxury.

Finally, there is a real risk of losing people to a more appealing system.  One of my new buddies, who will shortly qualify as a doctor here in the USA, shares my squirms about divides created by American healthcare, but the lure of the research opportunities as well as the healthcare facilities is, for now, just too great.  One could argue that neither of these are selfish motivations - the opportunity to do your best research, and give your patients exactly the treatment you want.  Friends of mine who took a 'medical gap year' to gain experience in New Zealand are starting to wonder whether long term the work conditions tip the balance in favour of the antipodes.

Me and my bestie, fellow Dr from the UK, who came to visit :)

I would not trade any coffee or sandwich in the world for the free universal healthcare we have in the UK.  Perhaps it is hard to see my American colleagues in their shinier buildings with all the perks that come of healthcare being seen as a business rather than a commodity.  But it is so much harder to see those who will never get to walk those corridors because of the neighbourhood or situation into which they were born.  I think I am only just beginning to realise the power and voice I have as a doctor to advocate for issues such as these that I feel we cannot and should not turn our backs from.

That said, I can't help but feel that in the UK we could do with being reminded that neither the NHS nor those who work for it are a commodity, and sometimes it takes looking at healthcare through someone else's eyes to realise that often they are seen as such (and not in a good way).  

Learning American music, making a good cup of tea and Fall

Despite Eva Cassidy singing about 'Autumn Leaves', it is most definitely 'Fall' in New England; we were marvelling today at how we probably have all the same foliage in Europe but somehow it just looks so much more beautiful here… perhaps the lack of rain?!

Anyway, the culture shock (and I mean that in a positive way!) continues as I adapt my British/German ways to my new American environment.  This week's highlights:

- I started playing in an orchestra this week.  Easy, I thought - the international language of music.  WRONG.  I grew up with bars, crochets, quavers, semi-quavers.  Here they have measures, full beats, half beats, quarter beats.  My desk partner probably thought I was heading for the exit when I had no idea what was going on at the start of the rehearsal and initially didn't play a note.  Two and half hours of sight reading later, I hope I managed to redeem myself.

- Milk.  Again, a surprise complication. In the UK we have full fat, semi-skimmed (green top, for some reason the one most people drink) and skimmed (white water). Here, there is whole milk, half and half, skimmed, 4%, 2%.... Confused.com.  And yes, it does matter which one goes in your tea.

- The pancakes are indeed as big as your face, but damn, they are good in the USA.  Don't get me wrong, I love a crepe, but how do they get buttermilk pancakes so fluffy?! This weekend I managed a double dose; I fear this may become a regular habit.

- Fall foliage really is amazing.  Here are a few snaps from East Rock running, and West Rock walking this weekend.  This meant we also braved the bus, which in a land with very subtle bus stop signs felt like something of an achievement.  It was so good to get some fresh air, and we were blessed with some glorious New England sunshine as you can see.  Although if post-grad medical exams are to be believed, I will be catching Lyme Disease at any moment.  I’ll keep you posted.

I am excited to have a VERY important visitor (my bestie!) this week.  I have done some baking specially (although this was also a mixed success – again there are certain ingredients e.g. flour I wrongly assumed would be the same! But hey, the first round still tasted good and simply means I will have to make more) and have cooked a batch of butternut squash soup. And I will be hopefully make some lab progress.  CRISPs(R), anyone?

How To Be a Brit in America

Greetings, dear reader, from this side of the pond!  I write to you from my new HQ in Connecticut, which I will be calling home for the next 9 months.  It's been a rather insane week since my violin and I upped sticks and landed here.  But my bags are well and truly unpacked, I have a bank account and a 'cell' number - frankly, my green card must be just around the corner (I jest, of course)...  Although it's very early days, I thought I would share my first reflections whilst they are fresh.  Perhaps they will prove useful to those considering a similar venture overseas, or will ring true to those who have made a similar move.  I'm sure I will laugh at these in months to come!

1) In the UK, I love black tea with milk.  You can buy tea in the USA.  Perhaps this is obvious.  The thing that is trickier is finding a kettle!  I have a whistling kettle in my flat that sits on the hob and makes me think of camping trips whenever I use it.  The thing other Brits and I have decided is distinctly absent is squash (to American readers - diluting juice?).  If anyone has a source in the USA, PM me!

2) Brits are (I believe!) famous for being very (overly?) polite.  Most Americans I have encountered are also incredibly polite - just about different things.  For example, I was profusely apologised to when the ATM I was asked to use to activate my bank account had a technical fault, and thus I had to move a WHOLE TEN FEET to a different ATM.  Conversely, it has made me realise how silly some of the things we apologise for in the UK are - e.g. the thing where if you are walking towards someone and will bump into them if one of you doesn't move, which brits feel the need to apologise for.  When really, no-one is at fault!

3) If going to the USA, always have a few spare dollar notes for tipping.  In the UK I was used to habitually tipping in restaurants (10%, usually), unless the service was truly awful.... and that's about it.  In the UK, I might round up a taxi fare if it was easier, or if the chat was good.  Some British people tip their hairdresser, or at a coffee shop if they have change, but again I wouldn't say it's expected.  Thus it is rather a culture shock to have to tip even the grumpiest taxi driver, and a rather heftier 15-20% in a restaurant.  It has been explained to me that tips are a notable part of peoples' pay, and as such, if I have under-tipped anytime this week, I can only deeply apologise.  I will improve!

4) I keep forgetting that tax is added to the price listed in shops.  This means I am never ready with the right cash - big sorry to anyone who has been kept waiting behind me in the queue this week.

5) Having a washing machine in your flat is a novelty in the USA (I have one in my flat.  Grateful ++.  I am way not organised enough to coordinate myself around taking it all to a launderette).

6) I'm sorry, but queuing really is a British art form.  This is based on not only this, but other world travels.  Queues happen here too, but sometimes people barge in, and then everyone gets really angry.  These two latter phenomena are simply not commonplace in the UK.  And even if someone did barge in, we would probably look at our feet, mumble or grumble a little (and quietly) and that's about it.

7) Open-ness and friendliness are definitely two of the best adjectives I can use to describe the Americans I have met so far here.  Despite me asking many moronic questions about how cell phone contracts work, how rental cheques are organised and how to send a letter to Europe, everyone has been incredibly helpful.

8) Getting some contacts together before I came here has been key to my early happiness.  I didn't know anyone in this part of the USA before I moved here, and just told everyone and anyone I met in the preceding months that I was moving here and was searching for friends!  It has been completely amazing how many people try and create contacts for you if you just ask, both before you arrive and once you're here; and I was amazed where such contacts ended up coming from.  My first few days have been completely 'made' by such contacts, and I have been blown away by their friendship and kindness; and ultimately many of these were also new to the area and keen to explore, so it's a double win - new friends, and someone to explore with!

9) Say yes to everything.  Thus far, I have met NGO workers at a cooperative BBQ I was invited to, painted in the middle of New York and drunk margaritas at the birthday party of someone I met that evening.  Random, and wonderful.

10) Sometimes it's bloody lonely.  It rained a flood on one of my first days here and I could barely leave the house.  I didn't really have anyone to call at that stage, and no-one wanted to go outside anyway.  I knew my family were busy.  I didn't want to simply call a friend in the UK within four days of arriving - I didn't think that was a good coping mechanism so early on.  But hey, that feeling passed.  And I ended up having a wicked evening with new friends.  I'm so lucky with what I'm doing, and I am trying to surround myself with reminders of that for future sad moments (which are inevitable, at home or away!).

I have, I guess, also been super lucky because as a Fulbrighter, I have access to the worldwide Fulbright community and more specifically the UK Fulbrighters based in nearby NYC who I met a few months ago.  What an awesome bunch of people!  I count myself as a very fortunate bean to be able to call them friends, and look forward to many more adventures over the coming months.  However this could definitely be YOU!  I didn't think I had a hope of getting a Fulbright, but it just shows you must TRY!  So give it a punt! http://www.fulbright.org.uk

Overall, I think the main reflections from my fellow UK immigrants and I are a new appreciation of how it feels to be a 'foreigner' and how we are determined to bring the 'international hand of friendship' back to the UK.

In the mean time, I could not be more grateful for every email or message I have had from friends and family, wherever they are in the world, and to all the new friends I am making.  Perhaps a good reminder to all of us to send a greeting to someone we know somewhere in the world, or someone we haven't spoken to for a while, and say hello to that new person at our place of work.  It's never too late!