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Wilkommen to my blog - my name is Karin Purshouse, and I'm a doctor in the UK. If you're looking for ramblings on life as a junior doctor, my attempts to dual-moonlight as a scientist and balancing all that madness with a life, you've come to the right place. I'm currently a doctor/research trainee in oncology after spending a year doing research in the USA. All original content is licensed under a Creative Commons Attribution 4.0 International License.

Saturday, 25 October 2014

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).  


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