Department of Hematology, Jianrong Sun
On June 5, 2016，with the considerate arrangement of our hospital, I went to St Georges Hospital Affiliated to St. Georges Medical College of University of London and started a 3-month clinical training. The learning experience was pleasant, precious and valuable although time was short. It opened my mind, and benefited me a lot. St Georges medical center has nearly 8000 employees, providing important medical support services for the whole southwest district. Major medical institutions of St Georges Medical Center NHS trust include Queen Marie hospital, Saint John Treatment Center and St Georges Hospital which is the largest one and the national key teaching hospital. In St Georges hospital, my identity is a clinical observer, so I can not participate in the clinical practice. Through observation and communication, I participated in ward rounds, outpatient service, case discussion, and so on to learn about the medical system and medical professional knowledge. My tutor is Dr.Fenella Willis, the director of the Department of Hematology. Most of the morning I followed her in the ward, while in the afternoon, I participated in some outpatient work. There were different forms of learning, including medical record discussion, obsevering plasma exchange, bone marrow puncture and hematopoietic stem cell transplantation and some other operations. Through the 3-month study, I obtained some experience and understanding of the medical system and environment, the relationship between doctors and patients, and the understanding of the local customs and practices in London.
1. The health care system: the British National Health Service system (NHS) has always been proud of the British government. Their service principle is, despite the individual age, occupation, residence, income (British citizens or foreign citizens holding more than 6 months visa), each citizen will share free medical services. But the premise is to choose a registeredclinic and get a “national health service card”. Its biggest feature is “fair” and “free”, which reflects the social fairness. British medical community clinics in the primary care function are very powerful. In the UK, the first diagnosis must be done in the community. If you go to the hospital, you must hold a general practitioner (GP) referral letter. Health care stratification services perform their duties, and they have been mutual protection and complement each other, so that it can make full use of medical resources at all levels and avoid overload and waste of resources. More than 90% of the primary medical services are provided by clinics; those who need special inspection or specialist services can be transferred to corresponding general hospitals; those who need organ transplantation, plastic surgery, cancer and other complex specialist treatment can be sent to tertiary hospitals. A variety of acute disease diagnoses and treatments directly go to emergency. GPs have become real community health gatekeepers. While the British GPs are not like our community doctors, they have received a systematic training, and have rich skills and clinical experience in gynecology and pediatrics, so they mainly deal with the majority of patients, so that hospitals and doctors can focus on key patients, hence save the cost and improve efficiency. All the patients I have seen in the clinic are admited by appointment of GP referral. The implementation of GP system eliminates the waste of medical resources and makes reasonable allocation to the maximum extent, which impressed me deeply. I believe it is a very effective method to solve the shortage of the medical resources in China.
The NHS system has great advantages, and is widely welcomed by the society, and envied by many countries. But the British people often complain about waiting for a long time. Generally speaking, they have to wait for at leat 1 month for hospitalization. Before going to the hospital, they also have to wait for GP recommendation and appointment. In order to save time, people with good economic conditions like to buy private medical insurance，which is more expensive. They may soon be arranged to see senior specialists in a private hospital.
2. The British doctor training system: in the UK, the doctor is a very prestigeous profession. Doctors have a high social status and are well-paid. But it’s very difficult to grouw out to be a registered doctor, which takes a lot of hard work and effort. Generally, the medical students study for 5 years to obtain an undergraduate degree in medical school, and then enter the hospital to be a Junior Doctor and accept a 2-year training (F1~F2), after that they have prescription rights; then they will start a Specialty Training (ST, 2 years of specialist training), known as ST1 and ST2; after passing the exams of Higher Specialty Training (HST) for 5 years, which were named ST3, ST4, ST5, ST6 and ST7 respectively, of Completion of Specialist by Certificate Training (CCST) examination, they can be registered as a Specialty Registrar (Doctor); finally they will have the opportunity to apply to become a hospital Consultant (chief physician). It is difficult to become a Consultant in the British hospital because the position of Consultant is limited. During the three months in St Georges hospital, I met a lot of fellows. Different classes for physicians have different training plans and examinations. Most of the examinations are mainly based on the clinical skills assessment, and each trainee must complete the training requirements of the specialized operation.
3. Advanced information systems: the general section of the United Kingdom’s information system is very powerful, they share both internal and external network, the information system standards are unified and comprehensive, and the patients share 100 percent of the appointment and treatment. Patient’s medical informtion can be shared through referral, which can effectively avoid repeated inspection. And the patient’s information is also quite rich and complete. Electronic data and paper medical records are backuped and at any time can be accessed. Computer of each department can be connected with the St Georges university library, the medical literature, guidelines and other resources can be accessed at any time. During the diagnosis and treatment process, any difficult problems encountered can be readily available; doctors can quickly find the relevant clinical manifestations of the disease, pathology, laboratory test results and related imaging performance, etc.
4. The harmonious relationship between doctors and patients: during my stay in the UK, I was most impressed by their support between patients and doctors. Patients and doctors trust and respect each other. The patients are very quiet during the outpatient waiting, their cordial greetings and farewells when they leave are very polite and friendly; personally I think it has a great relationship with their health care system. (1) Free medical care system, both doctors and patients have no direct interest relation, and all patients were treated fairly according to the illness, following the guidelines, which protects the doctor-patient relationship from the system and process. (2) Excellent medical environment: due to the full implementation of reservation, each consultant receives 10 appointments per day at most, which ensures that the doctor has enough time to communicate, exchange with and check on the patients. Hospital waiting areas were empty, clean and tidy. The hospital also attaches great importance to protecting the privacy of the patients, either from the process or the hardware design. (3) The doctor-patient quality: Britain is a gentlemanly country and only those who have high-quality and good education can be choosen to enter the school of medicine, and the patient’s cultural quality is relatively high, they have mutual respect with each other.
5. Humble attitude, rigorous style of work, positive learning atmosphere: British doctors are very modest, even the famous professors are no exception; during my study in the hospital, all doctors, nurses and consultants are very friendly to me. They would answer my questions whenever I ask them; the department held meetings twice a week, medical personnel are actively involved and actively speak. Secondly every clinical diagnosis and treatment is strictly based on GUIDELINE. There is a sound process in ward management, so the applications of antibiotics and blood indications and so on have a flow chart. Outside interference is less, the doctor’s main duty is to treat the patients, and they do not need to be distracted by other irrelevant things. The ward is well equipped, busy and orderly.
6. During the study in London, all the hospital staff are very enthusiastic and serious. Both the education center teacher or clinical teaching experts and professors, general nursing staff, are all warm-hearted and thoughtful to both their patients and fellows. Whenever I have any difficulty, they all are very warm, friendly to give help; my heart is full of deep gratitude to them.
The training in the UK is a rare clinical learning opportunity and experience to me. British counterparts’ hard work spirit, rigorous work attitude and style, high sense of responsiblity set a good example for me. I believe that through the study, I not only have learned certain improvement in clinical theory and practice, but also broadened my horizen and helped me to better handle the doctor-patient relationship.