Now that I’ve outlined three ethical situations that unconsciously affect the discussion of healthcare, I’d like to investigate some of the practical issue. The point here is not to make a judgment as to which system is better, but to compare them in a neutral light. I want to look at some of the common criticisms aimed at particular systems (primarily socialized medicine and private medicine) and examine them across the board. I will follow this part with a third that looks at the implementations of each system (finally).
The Problem of Waiting
In Michael Moore’s Sicko, the picture is painted that people in Canada, France, and the UK get VIP treatment when it comes to medical attention. This is partially true when it comes to seeing a GP/PCP. For instance, I can schedule a foreseeable, regular appointment (e.g. a regular checkup) with my GP and should be able to get an appointment two days out; I can also schedule an emergency, same-day appointment if I am unwell. The wait for appointments is minimal (5-10 minutes). However, this is really no different in the US.
In addition to these two types of appointments, most GPs in the UK offer phone consultations daily where doctors advise patients if there should be some concern or not and a daily open clinic where it is a first-come, first-serve basis (mine happens to be for one hour in the afternoon). Oftentimes, GPs in the UK still offer house calls as well for those who are physically unable to get to the clinic. These three are less common in the US primarily because they have very limited use benefits where access to personal transportation is the norm (e.g. since more people use public transportation, it may be very difficult for an ill elderly person to get to the clinic, so house calls are useful for that).
The situation is largely the same when it comes to emergency care. Ambulance response can be horrific in rural areas in both countries. However, the normative time for an ambulance when one calls 9-1-1 (9-9-9 in the UK) is very similar in both countries. Additionally, the ER (A&E in the UK) is prioritized for extremely urgent care and a non-urgent case can suffer a long wait time; however, this is because there are walk-in clinics for these non-urgent cases, usually right next to an ER. In these cases, the time for waiting isn’t much different in either country.
When it comes to special situations, there is less of a country-wide norm. Seeing a specialist in the UK requires a referral (like most in the US) and can take time if that specialist is overbooked. A six-month wait is not uncommon (but also not the norm!) in the UK, but this is also true in the US. I know of at least three different “specialist” practices in the US (two OB/GYNs and one urologist) had a wait time of 5-6 months because of overbooking. Similarly, I have heard numerous accounts of people in the UK saying that they only waited a week to see a specialist.
So, let’s face it, people will be waiting, regardless of how the system operates because waiting is linked to something other than the healthcare system, be it population size, number of specialists in an area, whatever. Even when it comes to operations, there are wait times. When I had a nasal surgery in Denver, I had to wait 3 months for an opening in the surgery schedule. We must be able to separate the practicality of scheduling a surgery with the ethos of how a problem is handled. In the UK, that ethos is one of “wait and see” and arguments for it stem from verifying that the action in question is the best one for that situation. This is a different ethos than that of the US which prefers (ideally) to prescribe an action right away (e.g. surgery, medication, etc). Taking into account the approval process on both sides of the pond, there really isn’t much difference in waiting for anything.
Continue reading ‘Healthy Practices’

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