Academia, England-style

Random Photo that Danny thought was funny:

Oxford may only be the 6th best university in the world (thanks, Stephen, for posting the link), but it's still an amazing place for a weekend trip and conference! Thanks to my cushy connections at the LSHTM, I got to attend a Health Policy conference earlier this week, held at Madgalen College in Oxford. The conference was Monday and Tuesday, but Danny and I headed out on Sunday morning to see just how Oxford compared to Cambridge (which, incidentally, just leaped over Harvard for best university in the world). Although the hands-down verdict is that Cambridge is better (I mean, who punts from inside the boat?!), we had a great time. Highlights of the visit included:

- Visiting Christ Church (which is a college, not a church, although it does have quite a large church), where some scenes from Harry Potter 1 and 2 were filmed, and where Charles Lutwidge Dodgson was inspired to write Alice in Wonderland. Alice was the young daughter of the dean of the college. Every night after dinner the dean would leave via a hidden door and back staircase - the white rabbit was based on him. Alice also had a cat named Dinah who would sit in a tree next to the library.

- Listening to bees. Just so you're assured that Oxford does have a hippy-dippy side, we visited a socio-ecological project where a guy has set up 2 bee hives, with a stethescope in each one so you can sit and listen to the bees doing their thing. It was pretty cool.

- Cream tea

- Dinner at one of Jamie Oliver's Italian restaurants. Tired of going to pubs and finding just one veggie option, we splurged for some home-made Italian goodness. And it was good.

- The Ashmolean museum: art and old things.

- The Museum of the History of Science. Lots of beautiful, hand-made astronomical tools that I don't understand, the original 1940 journal describing the use of penicillin (not that long ago!), several of Marconi's first radios, and a chilling display of the first anesthesia delivery system from the 1840's next to a bone-saw kit from the late 1700's. Ouch.


But it wasn't all fun and games and tea (although we did buy a new game, and we did drink a lot of tea). We were also there to learn. While Danny went to the Bodleian library to read the records of the conservative party, I began in earnest my foray into the social sciences. It was really great to think about the more large-scale aspects of health, rather than just how we treat diseases. Topics ranged from the fairly straightforward (do policies to include patients in safety efforts work, and what determines whether patients want to get involved) to the obscure-but-thought-provoking (focusing on social governance and the fate of all humanity rather than politial and economic gains).

The keynote address happened to be by Ted Marmor, on the recent health care reform in the US, and how we managed to get a "Republican style" plan that no republicans voted for (answer? US senate structure. and some other stuff). But he is hopeful that some of the new laws regarding private insurance may pave the way towards more universal, if not single payer, health care.

Another point that was driven home in this conference is that in the UK, health care policy changes all the time. Yes, the NHS has been in place since 1948, but they (politicians) feel the need to make some slight change every 2-3 years - changing the details GP contracts, changing public health priorities, changing the flow of money. All of which of course means that there's very little time to evaluate policies, and everyone does so under the assumption that they will just change in a few years away. And doctors have just gotten used to the idea that while the policies change constantly, once the dust settles they will go back to practicing medicine as usual. Whether that will be the case with the new White Paper, though, is anyone's guess. But more on that later. For now, it's off to Salzburg!

Two can play at this game: The History of Primary Care in the UK

I hope that many, many years from now, I will be remembered this way too:


This post falls under the "Remind me what you are doing in London?" category. While Danny is off in the archives, I will be working in the Health Services Research Unit of the London School of Hygiene and Tropical Medicine (henceforth known as The Trop). As many have pointed out, the name of this school is just dripping in colonial history (though to be fair, hygiene and sanitation improvements do more for public health than just about anything). My work will be on a "scoping study" of England, trying to see how general practitioners (GPs) and clinics are providing health-promotion and disease-prevention services. But more on my actual project when I start in August.

For now, I am doing background research on the history of primary care in the UK, how primary care is currently organized, what exactly the National Health Service does, etc. Today I was poking around the website of the Royal College of General Practitioners, which like all good British organizations, keeps great public records of its own history. One of the most interesting things was a collection of letters from the early 1950s, when the College was first starting to take shape. Apparently there were already Royal Colleges of several other specialties, like surgery and obstetrics, but general practice was always considered too mundane or antiquated to share this status. When a group of GPs got together and started floating this idea, they got some really nice letters from other GPs around the country, with very poetic descriptions of why general practice was such an important part of the medical tradition, and why a Royal College of GPs was so important.

From one letter: "It is not popular to insist among doctors that the GP is first and foremost a healer and that his primary aim is to restore wholeness or guide his patients towards health. Health may be undefinable, but is not difficult to recognise if present." And from another: "The general practice of medicine could at this present moment be standing on the threshold of an intellectual renaissance."

Interestingly, this call for the RCGP came about because of the creation of the NHS in 1948. The NHS dictated that GPs were all responsible for a health of a particular panel of patients in their geographic area, but did not allocate any funds for these doctors to meet the needs of their new patients. Underfunded and overworked, GPs started to deliver poor-quality care and became completely demoralized. They could not encourage any high-quality young physicians to go into the field, and there was some question of whether the profession would survive.

Sound familiar??? This is shockingly reminiscent of the "perfect storm" that Cambridge Health Alliance doctor Somava Stout talks about in a recent CNN interview. Lots of new patients getting insurance and entering the patient population (good!), but still difficult to attract young physicians to a career that involves piles and piles of paperwork and will not pay back their student loans in any reasonable amount of time (bad!). I don't think that primary care in the US will spiral like it did in the UK after the NHS came into being, but big changes in reimbursement, plus a culture change around medical education to re-invigorate medical students interested in primary care, are both necessary if we are going to weather this storm. Find out what Primary Care Progress is doing to help!