This is my second day working at a UK hospital and I honestly can't say yet which system is better, US or UK. There are a lot of problems I feel with the UK system. For instance, if a child has a complaint, a parent can't take them directly to a pediatrician. Instead, they must first go to a GP (general practioner). Then the GP either treats them or refers them to A&E or a pediatrician. So a general pediatrician is in a way a specialist. GP training varies widly and I very commonly hear the SHOs complain that the GPs have no idea what they are doing. In fact, some GPs have NO PEDIATRIC TRAINING. Amazing. On of the SHOs was complaining today about a kid she saw on inpatient who was "white as a board" and ended up having leukemia. She said that the kid was seen by a GP several times over the past week and the GP dismissed it. She said that it wouldn't even take a doctor to see that the kid looked near death and that something serious was going on.
On the plus side, there is a 4 hour wait rule in the A&E department, such that the hosptial is fined a huge amount of money if any patient stays in the ED for longer than 4 hours. WOW! Talk about amazing access to medical care! I told the SHOs that in the US its more like a 14 hour rule. So every patient we saw today was seen within 1-2 hours after presenting to the ED. If a patient is deemed stable to go home, they are discharged. If its unclear what there course will be, for instance today a girl with asthma was still wheezing after getting several treatments of salmeterol, they transferred to a holding unit where the general wards team looks after them. If they are ill, then they are admitted.
The A&E was so calm. Everything seemed to run so smoothly. Columbia's and St. Luke's ED always feel so chaotic, like a bomb just went off, or a tornado just swept through the buliding. Charts are everywhere, you can't even find the patient, and EKGs aren't with the chart. Its a nightmare. Here it was so ordely and calm. There are several waiting rooms for patients. I would bring a patient into one room, do the history and physicial, and then they would go back to the waiting room while I presented to the doctor. Then the room was free for another patient to go in and be seen.
There was one trauma case I saw today of a 2 year old, "pedestrian versus vehicle" as they say. There were no severe injuries but it was cool to be a part of the trauma team in the resuscitation room as we waited for the patient to come. After the trauma call goes out, ortho, peds surgery, peds neurosurgery, anesthesiology, the wards team and of course A&E reports to the trauma room. A&E does the initial assessment and whatever department isn't needed, A&E dismisses.
I saw mostly benign cases today, 2 soft tissue injuries the parents thought were fractures, and a petechial rash, unclear etiology, likely from viral infection.
My attending and I went over my schedule for the rest of the month. I'll have a lot of flexibility. I'll spend some time on neonatology, PICU and the various clinics. Other days I'll round with the ward in the morning and join A&E in the afternoon.
Living in London so far has been alright. I'm still don't know many people so it sucks to not be able to take advantage of what the city has to offer since I have no one yet to go out with. I just met a 2 more girls on my floor, one from Istanbul and one from Austria who invited me out tomorrow. I really appreicate people going out of their way to be friendly towards me.
Oh yeah, a funny thing happened today. I offered to call Homersmith hosptial to get lab results for a patient today for my SHO. By the way, you don't need to send any consent form to get results read to you or faxed from an outside hospital. All you need is the pateint's date of birth. Confidentialty breech! I dialed 0, then asked for the operator in the automatic recording but was instead transferred to somewhere else. I told the resident that the machine probably couldn't recognize my American accent. So I had to call back and say "operator" in a British accent, and that time it worked! haha.
Some things that English people actually say:
1. "Naughty", ex, "The surgeons didn't come like they were supposed to. Very naughty."
2. "Darling", ex, "Are you alright, darling?"
3. "Sneaky feeling" ex, "I've a sneaky feeling there won't be a lot of people at teaching confenence?"
4. "Isn't" or "hasn't" after any statement. ex, "Hes got quite a rash, hasn't he?"
5. "Loo, ex, "I'm just going to run to the loo."
6. "Cherrio", ex, "Cherrio"
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