Conclusion

--Overlooking some of the Island from the Sand Ridge--

--Dr Bingham and Dr Lovell arguing and posing--

Well I'm back home safely now. I was up something like 30 hours on 4 hours of sleep before I finally passed out. I'm set to enjoy the last few weeks before 2nd year and the ensuing grade competition that arrives mid-August. This summer has given me great insight into how another system of health care operates. The benefits and disadvantages may be different relative to those facing the US but the underlying trends and stressors are the same. I've also enjoyed the chance to understand the focus of public health and how it can work productively w/ the medical community to accomplish common goals. I spent much of my time addressing various sources/consequences of inequalities most notably deprivation and CVD risk, and prisoner and cancer risk. I've worked with every possible level of health care from hospital housekeeping to executive directors and seen the unique problems but common dependency they all share with each other. Finally, I learned a lot about the history, culture, and people of one Island and of England, in general. The people I've met this summer--especially in the public health office--are some of the warmest, most grounded and enjoyable individuals I've ever met. I felt like an emotionless robotic blob on the way home b/c I was so tired but the first feeling that came back to me this morning was regret for not thanking them all in full and that I already miss them.

I've been told my blog posts are too long and this won't be an exception. I'll try to just summarize some of my main concluding thoughts that compare the US and UK systems. My work on cancer and CVD prevention I think would best be left to the papers and not this forum.

1. More so than anything, the professionals, system, and patients in the UK and US are more similar than different. Health professionals have the same ideals, personalities, life goals, and aspirations while patients have the same diseases, fears, trust, and growing autonomy in care. Mental health access is an issue in both countries as physicians are not "formally" trained to treat such patients or do not have the time to do so properly. Physicians spend roughly the same short 7 minutes with patients, their practices struggle financially despite being overloaded, and all professionals work long hours.

2. Deprivation and inequality are important issues that contribute to significantly different health outcomes in both the UK and US. Though race is a bigger factor (partly b/c we have a bigger minority population) it also plays a role in the UK. Just like in the US doctors often are resistant to addressing this "public health" issue b/c they're overworked and are used to just treating whoever walks in the door.

3. Despite my previous assumptions, access to care is a huge issue in the UK like it is here in the States. Though it doesn't come in the form of inability to pay, it does in that patients must often wait some length of time to see a physician. "Elective" procedures of course also have a waiting time.

Part of it I think is patient education. Though I can't say this with any certainty, patients in the US seem more proactive and informed of their options when they enter the office. The UK is also shaking off the paternalistic medicine tradition but b/c our market is more about consumerism we may be a bit ahead of them in this regard. Contrary to what we're told in the States I would say that the physician profession has more autonomy and more political power than in our system. We're simply owned by HMO's and GP's in the UK are still very much independent businessmen/women.

4. The NHS (UK) is a tax based system focused on improving the health of the population overall and not necessarily on an individual level (no politician would ever tell you this). Therefore a lot of concentration is given to improving early life mortality (under 75) and not extending life beyond all possible means until we're little vegetables running around entirely supported by machines. Therefore, strict guidelines exist for which patients qualify for which procedures. This happens in the States, courtesy of HMO's, but we seem to be more lenient on drawing the line. I think anyone would agree that the NHS's way of doing things is better in that it saves money and ensures that everyone has roughly an equal shot at living a healthy, average lengthened, life---until they get sick. At that point you want to push for every possible chance of surviving even if it costs 1 million dollars and has only a 3% chance of working.

5. The interface of public health and the medical field is maintained better in the UK. Public health doctors have all (until recently) been trained as physicians first. Therefore they have the background and experience which validates (in the eyes of medical doctors) their viewpoints. I think the UK does a better job of at least talking about prevention and trying to incorporate it into the central focus of every NHS administration. I'm not sure if they actually deliver on prevention (they're 5 to 10 years behind us in screening--cervical, colorectal cancer, etc.) but the unity between public health and physicians is important.

It seems we're actually moving to the unification of the two fields. Curiously, the UK may be moving in the opposite direction. Medical training has been taken out as a requirement for public health and meetings between physicians and public health teams are beginning to be phased out with administrators now acting as the mediator.

6. The problems affecting both systems now and those that will arise in the future are identical. The aging population is causing worries in both the UK and US. For the NHS and our Medicare/Medicaid, the balance between young payers and old recipients is shifting in the scary direction.

The rising costs of new technology, cancer treatments, and life sustaining techniques is also stressing both systems. There is a push in both countries by the public for better, faster diagnostic tools that may increase outcomes but at what cost?

The advancing field of genetics and its potential to read your "health fortune" at an early age to predict your susceptibility and drug reactions is both amazing and scary. I've seen 4 stories just this week on the growing ability to quantify risk based on genetics. Both societies will have to struggle with the ethical issues that come up. Financially, though it will reduce the need for screening the entire population, I think overall it will lead to higher costs as people preemptively undergo unnecessary procedures to prevent fulfilling their genetic fortune.

The "grass is always greener" phrase really applies to health care systems. The UK public is crying out for more competition, choice, and consumer ideals while we desire all of our citizens to be insured and for medical costs to stop rising. The future of both systems is certainly not guaranteed. Though the NHS has far exceeded my expectations and reassured many of my doubts, I don't think a nationalized system is necessarily the answer to all of our problems. It would obviously insure everyone but the problems it carries may be as unacceptable to the capitalism-minded US public as the ones we face now.

It seems the answer, as it does in everything else, is in compromise. A mixture of the benefits of a private market as well as the support of public programs I think could solve our problems. Obviously, we have something like that in place now but the extreme costs of health care prohibit people from joining the private market and the public programs cannot afford to be inclusive enough. So, the market aspect isn't working and people are left in the middle. As for how to fix this...I have no idea. Maybe I'll learn that next summer but I think I should probably do something more clinical since all of my classmates have been out saving the world this summer.

Thanks for reading my attempt at a blog this summer. Take care!