When I first came to the United States I had occasion to interact with the American medical system on a number of occasions. This was the best system in the world – so it and its representatives claimed – and yet it seemed entirely dysfunctional. One would go to a health service for some minor reason and the first thing you would get would be a referral to see a specialist; no one seemed to be able to do the basic nuts-and-bolts of medicine. A blocked ear passage needing to be cleared, would result in a visit to an ear-nose-and-throat specialist, who would order up expensive tests; one would go away not wanting to have the tests, not getting the treatment so that the problem would only get worse and require more expensive treatment later. A gastro-intestinal reaction to some food would result in all kinds of EKGs, fears of drug addiction, and a whole bunch of other problems “that needed to be ruled out” – all at great cost and all coming back negative. The problem could never be the simplest and most likely cause – or this could only be acknowledged if everything else that it might be, from the rarest and most dangerous to the most obscure and improbable, had been ruled out. What a crazy way to run a system!
What always stuck in the craw somewhat was that whenever one interacted with an American doctor they could not treat you, or even just talk with you, without mentioning how bad the National Health Service in Britain was, and how great their medical treatment was by comparison. They had had no experience of the British system, so their comments merely reflected their ideological beliefs – or their nervousness that any suggestion that a public system could be effective might undermine them in some way. Whichever. I was in a position to correct their error, of course, having experienced both systems and finding the British one preferable, but didn’t do so – they were treating me after all, so it didn’t seem sensible to challenge their misconceptions.
I was reminded of these things by an article I picked up that my father, Ian Gregg, had written back in the 1960s. He had been provided various grants to go to the United States in 1965 to observe the way asthma and chronic bronchitis were being treated in American hospitals, and he wrote up some of his findings for the South London Faculty Journal (connected with the Royal College of General Practitioners). It should be noted that he was very much committed to the National Health Service, at one time being forced out of a practice in Kingston-upon-Thames owing to the fact that his partners wanted to practice some private medicine while he vehemently opposed this. He also noted that whenever he came to the United States and made favorable comments about the NHS, American doctors accused him of being a communist. Peculiar in many of his beliefs he may have been, but a communist he most certainly was not!
A couple of the points he made in his article were telling in this regard. The first reads thus:
A good illustration of the differences between the British and American outlook was provided by one of the papers which was read at the Assembly [at a conference in Winnipeg] by a Professor of Medicine from Chicago. He described emphysema as “a major public health problem in the United States, a crippling and prevalent disease”. No mention was made of the fact that the disease is usually preceded by a productive cough for many years. Had the lecturer been a British physician, he would almost certainly have referred to chronic bronchitis as being the major public health problem and he would have described emphysema as one of its principal complications.
No prizes for guessing which of the two, emphysema or chronic bronchitis, is easier and less expensive to treat! It also doesn’t take a great medical practitioner to determine that treating chronic bronchitis would reduce the incidence of emphysema, while chronic bronchitis rates would not be affected by simply treating people who had emphysema.
The other contrast between the two systems was found in a story told largely for humorous effect:
The next centre which I visited was Buffalo, where I had been invited to visit the University of New York [he means SUNY] and to be a guest speaker at a Medical Grand Round. A patient with asthma was presented and I was asked to discuss her management. This was not without its amusing moments which were greatly appreciated by the students in the audience. An allergist, who had treated the patient privately, made the intentionally provocative remark that, under the National Health Service, British doctors have no time to explain to patients the details of the treatment which they were receiving. He implied that one advantage of private treatment was the he could spend a great deal of time with patients which was so important in the management of asthma. The effect of these remarks was rudely shattered some moments later when the patient, in answer to one of my questions, admitted that she had no idea what treatment she was having, and whenever she had an asthmatic attack she just took any tablets which were to hand. Later on, it emerged that the reason for her being so markedly Cushingoid in appearance was that for some weeks she had been taking a large dose of prednisone (about six times the usual maintenance dosage) because she had not been told to reduce the number of tablets!
Oh well, the wonders of ideology; no need for actually knowing anything about one system or another – just repeat what you believe, just as if you were a doctor in Soviet Russia parroting the party line. Glad those days are over, and that we can move forward with a sane and rational system of health care available for all – a right, not just a privilege for a few. Oh no, right, we didn’t get that system did we!
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