Okay, this is the last post in the current series about primary care clinics. I did visit a 4th clinic last week, shadowing a GP I met at the Oxford conference on health policy, but nothing to report about that. Well, okay, two things to report. 1) It was awesome to see patients again! and to use my stethoscope! 2) It still gives me a thrill to be introduced to patients as "a visiting doctor from the United States", and to be able to provide "two doctors for the price of one," as she said (the price of one, of course, is £0).
But the main focus of this post is my experiences in Denmark, when I went with my host mom to the GP clinic where she works as a nurse. The clinic has 4 GPs and 2 nurses, all of whom were incredibly friendly and welcoming. Danny spent the morning reading in the conference room, and it seemed like one of the GPs was popping in every 20 minutes to chat with him, mostly about the only place in the US he had been (Boise, Idaho). I think I would be a pretty happy GP too if I had a 20 minute scheduled mid-morning break to enjoy a cup of tea and some fresh bread with cheese. Whether this is standard practice in Danish general practice or just happened at this clinic I don't know, but I could certainly get used to it. Just two main points about this visit.
1) The casual nature. I don't remember if I've mentioned this before, but no one in the UK wears a white coat. Not because they don't like to, but because they've been banned. The white coat, with it's dragging sleeves and lack of regular washing, essentially turns the wearer into a walking drug-resistant bacteria petri dish, and no about of gravitas is worth that. But it Denmark they take to a new level. Not only do they not wear white coats, or ties, but they are perfectly comfortable wearing jeans and sneakers. In fact, most of the male GPs were wearing black jeans and plaid short-sleeve button-down shirts. It was pretty sweet. The relationships between the staff and the patients was incredibly jovial and relaxed; I don't know how much of this is due to the Danish sense of humor, lots of longitudinal relationships, but some of it could be due to a lack of pretense that the doctors emitted (while still emitting confidence).
2) Freestyle, as needed health care. I think there is a fear in this county that with a government-run health care plan would come scores of regulations about the services that physicians have to provide, how often they have to provide them, and demands that patients "consume" health care in a certain way. And the UK is moving in this direction - all patients over 40 are expected to be seen once a year, and certain "screening" data is supposed to be collected (cholesterol, BP, weight, fasting glucose, etc). Of course, the ironic thing is that this is already the norm in the US, even without regulation. Because of the defensive and perhaps excessive way medicine is practiced in the US you can't walk into a clinic without getting a full range of vital signs taken (I just heard of a friend who had an EKG done as part of a routine checkup as a totally healthy 24 year-old!), whereas in the UK blood pressure is only measured if it is related to the presenting complaint (or now as part of scheduled screening or follow-up).
But in Denmark, which is even more of a scary Socialist country, these regulations are close to zero. No rules about how often you have to go in for a checkup (my host father hasn't seen a doctor in 20 years), no rules about checking cholesterol and blood pressure on patients that the doctor has no concerns about. At first I couldn't believe this. What about public health?! What about screening for "silent" diseases?! But I think the chart below, which I posted as a comment to an earlier blog, says it all:
Better outcomes for less money? Um, yes please. Interestingly, Denmark is "behind" much of the rest of Western Europe when it comes to life expectancy, so there is clearly room for improvement, but the point is that it's not lagging behind the US (in fact, it's marginally higher), and for much lower expenditure per capita. Of course, life expectancy is not the only measure of health outcomes, but I think it's a good place to start, no?
My point here is mainly that even within "socialized medicine", there is lots of variation in what a program can look like, and more specifically, it doesn't have to mean that the government is telling you or your doctor how to make every health decision. Besides, private insurance companies already do that, so it really shouldn't be such a scary idea for Americans...
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