So, I am beginning to writing this having already been working in the NHS in England for 5 months. In the beginning, I was too exhausted and too critical, and did not want my negativity to taint the record of my experience too much. I also really wanted to think that a nationalized health care system was fantastic, but felt just the opposite. So, a few months in, I think I have a better perspective.
My first job was at a hospital in Slough, which is where the UK version of the Office is set, if that gives you any first impressions. I was working the 3-midnight shift doing admissions. The A & E (ER) was so disorganized I could not really believe it. For example, in the minors area, there is no board (electronic or not) with a list of patients and their locations ("the patients move too quickly for that!") but rather you have to just look from bed to bed and try to find them. On my second night, I admitted a 95 year old previously fit and well (it is happening, I am talking like them!) man with sever pneumonia. He did not look good. I talked with my registrar (more on this later) about the possibility of him needing ICU vs. talking with the family about comfort-directed care, and she basically said- he is not for resuscitation and not for met (a pre-crash call). This is a medical decision, the family are not involved. So, I informed a completely unsurprised son of this and the patient dies a few hours later, with what I thought was insufficient morphine.
That is one huge difference- minimal family input on much of anything, as well as minimal family- doctor communication The nurses do the majority of the updating of the family members, returning their calls, etc. I speak with a family member of patient maybe 3-4 times per week while working on the wards.
Another difference is the approach to palliative care.- more on this later.
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