Experience and Impression of a Visit to British Hospitals
By Gang Liu (Kent), Chongqing Medical University, Chongqing, China
Gang Liu(right side) with Martin Hughes(in the middle), director of undergraduate in medical school of Cardiff University
I was sent to Wales to visit hospitals as a student for 8 weeks from August 1st, 2011, on an exchange programme between Cardiff University and Chongqing Medical University. I visited the University Hospital of Wales in Cardiff, Caerphilly Miner's District Hospital in Caerphilly and Prince Charles Hospital in Merthyr Tydfill, in which I rotated in several departments including Cardiology, ENT, Geriatrics, General Surgery and Orthopaedics together with students in the medical school of Cardiff University and trained doctors.
Cardiff University has a very good reputation all over the world and is ranked among the top 10 among the 106 universities in Britain. It is also a member of the Russell Group. Professor Sir Martin Evans, President of Cardiff University, was the first scientist to identify embryonic stem cells. In 2007, he was awarded the Nobel Prize for Medicine for these “ground-breaking discoveries concerning embryonic stem cells and DNA recombination in mammals.” The University Hospital of Wales is the best in Wales, and is also known as one of the largest in Europe, providing 24-hour Accident & Emergency and various other specialist departments. It is also a teaching hospital for Cardiff University School of Medicine.
I didn't see any big differences in patient admissions, doctor ward rounds, drugs or surgeries between British hospitals and Chinese hospitals. However, in the eyes of a student, there are some outstanding differences which impressed me a lot, among which are as follows:
1.Different medical system. The UK has had a National Health Service (NHS) since 1948. Every legal British resident enjoys the right of free medical care including food, and everyone in UK including temporary visitors has the right of free medical care if it is an emergency. In the NHS system primary health care is conducted by General Practitioners (GP) while specialist health care is conducted by consultants who are specialists. Everyone in a community has his own GP. When sick, a patient should first see a GP. If further special treatment or surgery is needed, a letter would be written by the GP to introduce the patient to a consultant, which is quite different from the Chinese medical system where a patient can freely choose doctors and hospitals. A patient has only one admission number in his lifetime and all the medical records are in one file which could be viewed when needed either to check paper documents or electronic documents, which makes it easier for a doctor to know better the patient's condition and for the NHS system to administer to the health needs of millions of residents. Whereas in China, any patient could have hundreds of admission numbers, different doctors and medical records which are incomplete or out of order, which makes it hard for a doctor to analyze when seeing a complicated case with many chronic diseases. Much time is spent in taking a history, especially from those who are old or confused and don't have a good memory. It would even be harder to diagnose, evaluate and give drugs without any medical records.
2.Attitudes towards medicine. Diagnoses and treatments are based on evidence. Though using advanced equipments, UK doctors still believe that taking a case history and clinical findings play a very important role. Laboratory test results are often reported within hours after a sample is sent and even could be faster if it is an emergency. Doctors are extremely responsible, serious, precise and strict in every detail, but not dull. They still make small jokes during their free time to create a pleasant and relaxed atmosphere. They hold the idea that diseases of the body itself are only one aspect for concern and treatment. Doctors care about the patient’s quality of life, psychological problems and communication. For a certain diseases, most of our Chinese doctors value the diagnoses and treatments while doctors in UK would think further about the etiologies and complications. As a result, they do much better in disease prevention. They call “communication” the most important and effective drug, doctors are also expected to be good at communicating. “Quality is more important than quantity.” as a doctor explained, “for a dying patient there are few things we could do. However, by good communications, the patient and family will realize we are caring and respecting their dignity. This is even more powerful than any other drug!" Doctors and nurses try to create a better condition to help the sick body heal itself by providing both physical and mental support. Drugs are given when necessary. A 60-yeat-old gentleman with liver disease and bad appetite, whose albumin level was less than 23 /L, had ascites and bad edema over the bilateral legs. Doctors didn't give albumin by intravenous infusion. Instead, they encouraged him to eat as much as he could. To my surprise, he recovered much better in the following 10 days.
3.The way to train students and doctors. As the same in China, it takes 5 years to graduate from medical college. However, medical students spend the first 2 years in school learning the basic medical knowledge and communication skills by reading numerous books based on the lectures given by professors such as Anatomy, Pathology and Biology. The following 2 years are spent in teaching hospitals to learn clinical skills and special courses such as Physical Examination, Internal Medicine and Surgery. The reason, as explained by a professor, is to put theory and practice together to let students understand, digest and grasp better and more easily. Whereas in China, most students spend much time in campus reading textbooks, attending hundreds of obsolete classes and little time in clinical practice. Students in Britain are encouraged to learn actively by themselves. The final year involves rotation through several departments. Before doing any clinical procedures, students are required to practice on a model hundreds of times and get familiar with every step. After graduating, students can choose either to be a GP for at least 9 years training and medical education or to be trained over 15 years to become a consultant. The training for a doctor is "one to one". A consultant who is an educational superviser will tutor a junior doctor till the end of that doctor’s training. Consultants may train a number of junior doctors through their clinal supervision. In China, a consultant or a senior doctor usually has more than 2 students and it is not uncommon that medical students become doctors immediately after graduating without any further regular training. All of the trained doctors rotate and work in different level hospitals all over UK assigned by British Royal Society for Medicine, as a result, every GP or consultant has almost the same medical skill level after the training programme. Doctors are not required to achieve any PhD or Master’s degree while in China, a doctor’s degree matters his promotion and career.
4.Relationship between doctors and patients. I didn't see any fights between doctors and patients, which is quite common in China. Doctors and patients live in harmony with trust and respect for each other. A doctor should get permission from the patient for anyclinical procedures. Doctors spend most of time in listening, talking and explaining with lots of patience and politeness, and try to meet all reasonable requests. They work with great responsibility and enthusiasm. However, it sometimes happens that doctors are sued by patients. One good example, a consultant told me, was that a doctor gave blood transfusion to a patient who was nearly in shock because of too much bleeding, who turned out to be a religious follower whose religion was against accepting foreign blood. After waking up, he took the doctor who saved his life to court and won. So doctors in UK are still cautious about working and avoid making any tiny mistake.
5.MDT working. Multi-Disciplinary Team (MDT) working is popular in British hospitals, especially in Geriatrics. The team consists of physicians, physiotherapists, occupational therapists, pharmacists and nurses. In MDT, nurses are supposed to be present on ward rounds and report the patient's daily condition to doctors including matters relating to activities, eating, drinking and stool. Then physicians and pharmacists focus on treating the disease by giving drugs while physiotherapists and occupational therapists are responsible for the capacity and quality of living and social life. Everyone in this team is equal, free to present ideas, in order to discuss and evaluate the patient's condition, aiming to provide better treatment.
6.Continuous Education. The NHS system requires doctors to keep up with current medical practice and continuously to renew their knowledge. The hospital creates many opportunities for continuous professional development (CPD). Unlike in China, doctors do not have a noon break. A presentation is usually given by a team at lunch time to introduce some new research or interesting cases, etc. Sometimes, during the presentation, senior doctors will perform clinical procedures on a model step by step to make it easier to understand, such things as chest drainage. Lecture is the common way to educate,
7.Doctors with full capacity. Doctors in UK can take both venous and artery blood samples, perform vein punctures and intravenous infusion all by themselves while in China those procedures are performed mostly by nurses. Every doctor is capable of basic clinical practices. The first few days when I was in the Cardiology department, a senior doctor could diagnosis, prescribe, perform ECG and echocardiography, operate coronary angiogram and pace-maker surgery very well and accurately, which impressed me a lot.
8. Infection prevention. British hospitals are very serious about infection prevention, To reduce the risk of hospital infection, many steps are taken. Families, relatives and friends who want to visit the patient have fixed visiting times, usually during 9:30---11:30 and 14:30---16:30, with no more than 4 persons at a time permitted at their bedside. Wards, beds and instruments are cleaned everyday with bactericide. Doctors and nurses are required to wash hands before contacting patients, and even to wear hat, mask, gloves and isolation gown in some certain cases, such as deep venous puncture. There is no extra bed in any ward. However, a patient can be admitted into another different ward while remaining under the charge of the original department. As a result, morbidity from hospital infection in UK has reduced by 14% during the last 10 years.
There are some weaknesses I still notice. In the NHS, some patients would wait for months to see a doctor, which might lead to a worsening condition or even death without any timely medical intervention. If the GP carelessly evaluated a patient’s condition, which actually was severe and beyond the GP’s limits, so he didn't write to a consultant, the best time to treat the disease would be delayed. A small group of people could cheat the NHS. Some people who don't want to take care of the elderly would send their parents into hospital with the excuse of illness and never come back. Some people who get drunk or have small injuries would call the emergency services. As a consequence, lots of money and resources are wasted.
There are some friendly suggestions I would like to particularly make to those who are going to visit British hospitals as a student.
1.Improve English. Nowadays in China, most people speak American English. Please try to learn British English as well. Make sure you get used to the elegant accent. In addition, you will find many foreign doctors or students from more than 10 countries including India, Pakistan, Iraq, Malaysia, Germany, France, America, Nepal, Iran, Egypt and China in hospitals. Sometimes you can hardly understand what they say with a strange unfamiliar accent, but the more you practice and listen, the better you can understand and get used to it. For a medical student, it is very necessary and important to grasp a lot of medical words and abbreviations so that you can understand and express yourself well. For example, “SOB” means short of breath, “CVD” means cerebral vascular disease.
2.Medical knowledge preparation. Prepare medical knowledge on every aspect as much as you can. It would be better if you could contact clinical practice and visit patients before going, so that you could compare and get to know better the differences between Chinese Hospitals and British Hospitals, thus to form a good conception of western medicine.
3.To know some cultural differences. It is true that British people are very friendly, but it is still necessary to learn some different cultures to be polite in hospitals in order not to cause conflict. Chinese students are encouraged to be assertive in asking for help. Even if it feels strange to do this, do not wait quietly to be told what to do. UK medical students are expected to be pro-active and assertive. In a multi-cultural society such as Britain you will not be assumed to be a ‘foreigner’!