On March 24, 2016, I was selected by Binzhou Medical University Hospital to participate in an international training project in the UK. After a long flight of 8500 km, I arrived at the Hammersmith Hospital in western London. After a 3-month study in the UK, I obtained a good understanding of its medical development, management, national health system and the physician training system, which not only widened my horizon, but also updated my medical philosophy.
1. The British NHS
The National Health System (NHS) has been established for nearly 7 decades, which provides free medical services for all citizens. The overall health spending accounts for about 10% of its GDP.
The British public medical treatment process is associated with the implementation of strict hierarchical system of diagnosis and treatment. The NHS consists of community health care，secondary medical care and tertiary medical care (rehabilitation). Community health care is one of the most important links, providing such services as general practice, dental clinics, community pharmacies and optometrist. The NHS is the “main screen” for patients, which is followed by secondary medical care and tertiary medical care. The British Government encourages each citizen to go to general practitioner (GP) to register. Most of the treatments provided are free of charge, and GP must agree before the patient is referred to a higher level hospital. The essence of the British health service is to let all people enjoy medical service. For most people, general clinic is the first entrance of the NHS, which is relatively mature even though there still exists limitations. In the UK, sometimes a medical appointment for inspection may need one or two weeks to go. Sometimes it needs a month or two if the patient wants to be hospitalized. Its efficiency is better than ours. It is almost impossible to see medical disputes there. It is foreseeable that the grading diagnosis and treatment is the key to solving the serious doctor-patient relationship.
2. The British doctor training system
The training of a doctor in the UK is as strict as that in America, although its income level is inferior to the US and Canada, trainees still have to pay great efforts to master the skills and theory to pass the training.
The picture above shows the training route for an anesthesia doctor. They have to go through the 5-year undergraduate study before entering the hospital. They must accept the Basic Training (2~3 years) and Specialty Training and finally becomes Consultants (5 years). Every anesthetization must be carried out senior anesthetists. Anesthesia specialists can implement general anesthesia, urological and gynecological surgery. Most of the doctors are full time employees, and a few are part-time researchers.
Junior doctors’ income consists of two parts: salary + overtime work bonus, the lowest junior’s income at Hammersmith Hospital is around 23,000 pounds per year. Consultant only has annual income. How much they earn is associated with their length of service, the salary of their first year is about 75,000 pounds, the highest level of a consultant’s (19 years) salary is about 130,000 pounds. Some consultants are licensed to work at several different hospitals.
3. The Imperial College
Imperial College, founded in 1907, is one of the world’s most prestigious universities. Its research ability is recognized as one of the best among the universities in British. The Imperial College is the first big British academic research institute cooperating with China, and its Chinese partners include Huawei Corporation, China South Locomotive, Tsinghua University and Zhejiang University. Chinese president Xi Jinping visited Imperial College in 2015. There are currently more than 2,000 Chinese students studying at Imperial College.
4. Hammersmith Hospital
Hammersmith Hospital is affiliated to the Imperial College which possesses five hospitals: Charing Cross, St Mary’s Hospital, Hammersmith Hospital, Queen Charlotte’s and Chelsea.
Hammersmith Hospital, founded in 1912, is a surgical and teaching hospital. It has 349 beds and is famous for superb medical research; its clinical research is internationally renowned.
We can’t participate in operation due to our observership so we studied by observation, communication and participation in case discussion.
Hammersmith Hospital has eight surgery operating rooms, each of which is controlled by the general anesthetist with 1-2 residents and one anesthesia nurse. Hammersmith Hospital has 19 consultant anesthetists and 13 anesthesia nurses. At 7:30am, junior doctors will check narcotic drugs, machines and make everything ready for the surgery. Before entering the operating room, patients will be examined carefully by anesthetists and nurses. The surgeon will review the patient’s general condition, exchange views, and make preparations. After the patient enters the operation room, the anesthesia nurses will check his information once again. Everybody attaches great attention to every patient’s heat preservation. The monitoring is very good in addition to the previously mentioned creative arteriovenous pressure monitoring, temperature detection, depth of anesthesia monitoring, TEE, anesthetic gas concentration monitoring and carbon dioxide partial pressure, etc. All patients wear medical stretching hoses to prevent venous thrombosis. When the operation is finished, the team will check the patients again and decide the next step for the patient. If the illness is lighter, the patients will be sent to the recovering room after pulling out the endotracheal tube, if the condition is serious, they will be sent to the CICU.
The medical staff does not need to wear face masks when they come into the operating room, which is quite different from our practice. If doctors don’t need to arrive at the specific operating room, they won’t change slippers but wear casual shoes. Laminar flow operating room works 24 hours a day to ensure the maximum sterile environment.
According to the training plan, I learned extracorporeal circulation technology in addition to study anesthesia. Each operation room has a Stocket S5, a world first-class extracorporeal circulation machine. And each machine is equipped with continuous blood gas monitoring, arteriovenous pipe temperature monitoring, bubble monitoring, fluid level, the ACT, pipeline pressure monitoring, extracorporeal circulation information system, which work together to guarantee the safety during extracorporeal circulation. My supervisor, Dr. Bishop Henry, the chief perfusionist, is kind but very rigorous. Extracorporeal circulation department has a total of five perfusion physicians, during the CPB they abide by the same principle, which is carried out in accordance with the unified operation process. Perfusion physicians are also responsible for autologous blood doping. When extracorporeal circulation pipe installation is completed, they will check monitoring system item by item by to minimize the risk of accident.
Extracorporeal circulation process contains blood by using liquid crystals which is used to stop the myocardial perfusion halts. Observation shows the PH and electrolyte of most patients during postoperative period is within the normal range.
The application of the intraoperative autotransfusion makes the procedure smooth, saves much blood and alleviates the shortness of blood supply.
Residency lectures are held every Tuesday morning. One senior resident usually delivers a lecture and every resident will take part in a following discussion. During the discussion, I find all residents are theoretically well-grounded.
5. Reflections and implications
I believe the study in Britain will be an invaluable experience in my life. UK colleagues’ rigorous work style, work ethics, sense of responsibility and humaneness all set a fantastic example for me. Efficient and reasonable health care systems, harmonious relationship between medical staff and patients have great referential significance for us. Through the 3 months of learning, I not only have improved my medical theories but also broadened my vision and understanding. What I have learned also gives me some reflections and implications: 1） there is no significant difference between our medical technology and the international technology; 2）Our attention to details, care for patients, doctor-patient relationship and the whole medical system need to be better improved and reformed.
Through the study in London I realized how wonderful the outside world is and how fast knowledge is updated. In the near future, I will put what I’ve learned in the UK into clinical practice and try to serve the patients better and better.