United Kingdom: The NHS
It's the autumn of 2010. I've been in London as a student for a couple of months. Today I'm going to register with a GP, the equivalent of a PCP in an American HMO. This will be the doctor in charge of my general medical care, who will refer me to any specialists I need to see, who will write all my prescriptions. I've chosen a surgery (what the Brits call a doctor's office) based on recommendations from friends in the area. It's about five minutes walk from my apartment, and just around the corner from a pharmacy (or chemist, as they say).
The doctor's surgery is in an old building. The waiting room is lined with about twenty plastic and metal chairs. It's painted in pastel colors and looks nothing like any doctor's office I've ever been in in the US. In those, everything is shiny and new looking, and very clean. This office is clean bu well used , which doesn't bother me. But it is different from what I'm used to. I realize I feel slightly embarrassed to be getting what seems to be free medical care.
There is a strong stigma in the United States against receiving government benefits. Even at my poorest, I never signed up for Medicaid. I have to resist the urge to flee, as there really is no other way for me to get treatment. Also, the other patients in the waiting room are well dressed, and obviously not hurting for money. I ask a British friend if rich people go to other doctors. He assures me the rich are the first to take advantage of free things. And anyway, he tells me, the NHS has a much better survival rate than private doctors.
At my sign up visit, I have to show my passport and immigration documents. I see a nurse who takes my medical history and explains how the British system works. She spent some time in America, she says, so she knows that our system is different. The big reason for the sign up visit, from what I can tell, is that they want to make sure you're not diabetic. She gives me a container and sends me to the toilet to provide a urine sample, which she tests in front of me. She pronounces me free of various illnesses based on this. I blink at her awkwardly and hand her a letter from my American doctor which reveals that pretty much everything she just told me was wrong. I find this worrisome.
I give her a list of my medications. She writes them down, asking me what each one is for. About one of the important ones she tells me 'we don't do that here.' This makes me extremely worried.
I leave the appointment signed up for a GP, but feeling concerned about what kind of care I can get where so much is wrong about what I've been told.
A week later I see the doctor, a young blonde woman who looks barely old enough to have finished university. My doctor at home was in her forties. This doctor is timid seeming. She asks me questions, but never comes close to examining me. This will be my experience with most doctors in the UK. Only once has a doctor listened to my heart or lungs or felt the glands in my throat. Every doctor I had in the US found some reason to examine some aspect of me. The hands off approach makes me a bit nervous.
I repeat to her what the nurse told me about my prescription. She assures me that the nurse was wrong. They do in fact use the drug I take to treat my condition.
On this first doctor visit, the doctor gives me a printed out green form with my prescriptions on it. I leave the surgery without paying a penny and take the form to the chemist around the corner. Patients pay £7.20 (now £7.45) for prescriptions. It's possible to get out of this co-pay for various reasons written on the back of the form. If you're poor, or have certain serious health conditions, for example.
Every time I need a prescription filled, I have to take the refill request to the doctor's office and drop it off. It takes two days to get a new prescription and occasionally the doctor will want to see you again before giving you a refill.
That's all there is to it. Every once in a while, I will get a form in the mail asking whether I'm still at the same address and confirming which surgery I'm registered with.
The things that are different about this experience have more to do with interpersonal relationships than the medical systems. In the US, I was on a first name basis with some of my doctors. I could email them prescription renewals directly. I could call them on their personal lines. Nothing like that happens here.
Before I came here, my father warned me how much I was going to hate the English medical system. His business partner is English and he complains about it all the time. I hoped he was wrong. There are things I don't love about it. I often feel talked down to. There is not nearly as much explanation about what's wrong or why something is being suggested. I often feel as if I have no choice but to do what the doctor says.
There are techniques to get the patient to comply. I'm not in favor of these because they don't take into account what I know about my own health. But these are just signs of the difference in our cultures. They have little to do with whether the medical system is working.
I've also noticed that there is a general lack of the sophisticated equipment that my doctors had access to in the US. Of course, I was at a fairly prestigious University teaching hospital, so they had a lot of money. As far as I can tell, the lack of this equipment has made no difference to my health. At worst it means test results aren't instantaneous.
In my next article, I'll compare emergency room treatment.
The doctor's surgery is in an old building. The waiting room is lined with about twenty plastic and metal chairs. It's painted in pastel colors and looks nothing like any doctor's office I've ever been in in the US. In those, everything is shiny and new looking, and very clean. This office is clean bu well used , which doesn't bother me. But it is different from what I'm used to. I realize I feel slightly embarrassed to be getting what seems to be free medical care.
There is a strong stigma in the United States against receiving government benefits. Even at my poorest, I never signed up for Medicaid. I have to resist the urge to flee, as there really is no other way for me to get treatment. Also, the other patients in the waiting room are well dressed, and obviously not hurting for money. I ask a British friend if rich people go to other doctors. He assures me the rich are the first to take advantage of free things. And anyway, he tells me, the NHS has a much better survival rate than private doctors.
At my sign up visit, I have to show my passport and immigration documents. I see a nurse who takes my medical history and explains how the British system works. She spent some time in America, she says, so she knows that our system is different. The big reason for the sign up visit, from what I can tell, is that they want to make sure you're not diabetic. She gives me a container and sends me to the toilet to provide a urine sample, which she tests in front of me. She pronounces me free of various illnesses based on this. I blink at her awkwardly and hand her a letter from my American doctor which reveals that pretty much everything she just told me was wrong. I find this worrisome.
I give her a list of my medications. She writes them down, asking me what each one is for. About one of the important ones she tells me 'we don't do that here.' This makes me extremely worried.
I leave the appointment signed up for a GP, but feeling concerned about what kind of care I can get where so much is wrong about what I've been told.
A week later I see the doctor, a young blonde woman who looks barely old enough to have finished university. My doctor at home was in her forties. This doctor is timid seeming. She asks me questions, but never comes close to examining me. This will be my experience with most doctors in the UK. Only once has a doctor listened to my heart or lungs or felt the glands in my throat. Every doctor I had in the US found some reason to examine some aspect of me. The hands off approach makes me a bit nervous.
I repeat to her what the nurse told me about my prescription. She assures me that the nurse was wrong. They do in fact use the drug I take to treat my condition.
On this first doctor visit, the doctor gives me a printed out green form with my prescriptions on it. I leave the surgery without paying a penny and take the form to the chemist around the corner. Patients pay £7.20 (now £7.45) for prescriptions. It's possible to get out of this co-pay for various reasons written on the back of the form. If you're poor, or have certain serious health conditions, for example.
Every time I need a prescription filled, I have to take the refill request to the doctor's office and drop it off. It takes two days to get a new prescription and occasionally the doctor will want to see you again before giving you a refill.
That's all there is to it. Every once in a while, I will get a form in the mail asking whether I'm still at the same address and confirming which surgery I'm registered with.
The things that are different about this experience have more to do with interpersonal relationships than the medical systems. In the US, I was on a first name basis with some of my doctors. I could email them prescription renewals directly. I could call them on their personal lines. Nothing like that happens here.
Before I came here, my father warned me how much I was going to hate the English medical system. His business partner is English and he complains about it all the time. I hoped he was wrong. There are things I don't love about it. I often feel talked down to. There is not nearly as much explanation about what's wrong or why something is being suggested. I often feel as if I have no choice but to do what the doctor says.
There are techniques to get the patient to comply. I'm not in favor of these because they don't take into account what I know about my own health. But these are just signs of the difference in our cultures. They have little to do with whether the medical system is working.
I've also noticed that there is a general lack of the sophisticated equipment that my doctors had access to in the US. Of course, I was at a fairly prestigious University teaching hospital, so they had a lot of money. As far as I can tell, the lack of this equipment has made no difference to my health. At worst it means test results aren't instantaneous.
In my next article, I'll compare emergency room treatment.
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