Dong Liu Orthopaedic Trauma
With the help of the hospital leaders, International Affairs Office and my director (Kai Zhang), I had an opportunity to participate in the advanced study program of St George’s Hospital Affiliated to London University in June 2016. After completing this program, I can’t wait to share my fantastic and valuable experience which broadened my horizons, enhanced my academic level and enriched my knowledge about British culture.
1. Introduction to National Health Service(NHS)
NHS, which makes British proud and is the hallmarker of British civilization, has was created in 1948, financed mainly by taxation. Compared with most European countries and America, the expenditure of NHS of the UK takes up less proportion of GDP, however, NHS system is regarded as the most economic medical system, which provides the equal medical health service for all citizens. The British government encourages people to choose community health centers. The whole medical service system is centered on patients, which makes inpatients get the fastest and the safest treatment. Emergency service, which is taken over by NHS Trust, offers medical service for the people who is in the UK.
For now, NHS is a complete medical administrative system, including home-care, class-Ⅰhospitals, class-Ⅱhospitals, and class-Ⅲ hospitals. Most of doctors, nurses and other health professionals are working for NHS; some others sign a contract with NHS.
Community health centers are the pivotal segment. All citizens must register their information with general practitioner (GP), and then they can get free medical services. A patient can’t visit any doctor in any class-Ⅱhospital without general practitioner’s recommendation. A community health center, which faces most patients and is responsible for personal health, is composed of a general practitioner, a community pharmacy, a dental clinic and an optometrist. The principle of NHS is that all citizens can get medical health service. Most patients walk into a community health center (the first door of NHS) and get treatment. Otherwise, their general practitioners will recommend specialists for them，vice versa, specialists will transfer them to their general practitioners. The characteristics of emergency nursing are providing clinical support for citizens who need emergency service.
1. Introduction to Doctors’ Training System and Income
In England, doctors are prestigeous and respected and they belong to the elite with higher social status and higher income. Of course, it is not an easy thing to become a registered doctor; you need to make a dramatic effort to complete your training program. Basically, you will keep studying in a hospital as a junior doctor after studying in a medical school. You will acquire the right to prescribe medicine or treatment for patients after completing foundation training (F1, F2). Moreover, you can keep going for two years of Specialty training (ST1，ST2), and for five years of higher specialty training (ST3-7). After obtaining a certificate of completion of specialist training (CCST), you will become a specialty registrar (same as attending physician or associate chief physician). Eventually, you can apply for a consultant. The number of consultants is constant, and national specialty registrars can apply for the same consultant position. However, if you want to apply for a consultant position, working in the hospital, or having a good reputation is your advantage. A well-known doctor can be brought in as a talent.
You need to expend three more years if you want to be a maxillofacial surgeon who must acquire two degrees：medical degree and dentist degree. You can expend five years on getting a medical degree firstly, and expend three more years on getting a dentist degree. Either, you can expend five years on getting a dentist degree firstly, and expend three more years on getting a medical degree.
British Medical Association (BMA) is the organization of all medical staff. Annual salary of every rank from junior doctor to consultant can be looked up. The income of youngest junior doctors, which mainly comes from annual salary, is 23, 000 pounds. The income of the first years of consultants, which mainly comes from annual salary and private surgery, is 75,000 pounds. The income of senior consultant is 10,100 pounds. Junior doctors may study in different hospitals and move house, and their life is hard. The income of specialty registrars mainly comes from annual salary and night duty allowance, which is more than salary. The most important thing is having a good reputation.
Retirement age of doctors is 65-year-old. But most doctors look younger than they are, so most of them are still working because their income is the highest and they have six weeks paid vacation at this stage.
2. Introduction to St. George’s Hospital
St. George’s hospital, which is the national key teaching hospital located in London, derives from the hospital affiliated to St. George medical school of London University built in 1733.St. George’s hospitalis one of the biggest hospital and cultivate many medical talents for hospitals. The hospital motto is excellent, kind, responsible, and respectful. Many excellent schoolfellow had studied in St. George’s hospital, including John Hunter who is the famous surgeon, and anatomist, and the founder of experimental surgery and anatomy and is called the father of surgery, Edward Jenner who invented the smallpox vaccine and is called the father of immunologist, and Henry Gray who is the author of Gray’s Anatomy called the bible of anatomy. For now, the newest Gray’s Anatomy is the 39th edition. The first CT scanner landed in St. George’s hospital in 1971. The inventor of CT scanner (Housefield) acquired Nobel Prize in medicine.
St. George’s Hospital
St. George’s hospital belongs to public hospital of NHS, where the cost of patients including outpatient service, inpatient service and meal fee is covered by government. St. George’s hospital can not only meet local medical demand but also offer health care for sophisticated case, such as emergency department, stoke treatment department, cardiology department, neurosurgery department, kidney transplant department, maxillofacial surgery department and oncology department. Of all department, cancer center and stroke treatment are excellent. Accident&Emergency department (A&E), which is the biggest emergency treatment center in southwest London, can provide helicopter emergency medical service (HEMS).
St. George’s hospital makes you feel quiet, tidy and comfortable. The equipment of St. George’s hospital is modern. There are lawn and parterre in everywhere. There are art paintings and photography products in room and corridor. There are sofa, tea table, lamp, drinking device, magazines and brochure in a service counter. There are a spacious cafeteria and a store with all daily supplies in St. George’s hospital. However, there are not a lot of patients in every department because general practitioners need making an appointment with specialists for patients ahead.
In England, doctors wear individual suits but not white coat in every department or clinic except operation room. It is said that the cuffs of white coat are the main route of transmission of nosocomial infection, even though doctors pay attention to hand hygiene. Therefore, it is mandatory for doctors to wear a short sleeve shirt. In England, doctors must dress themselves up. Male doctors must wear long-sleeved blouses with sleeve cuff on upper arm, suit pants and leather shoes and cover the bottom of blouse with pants. Female doctors must wear knitting cardigans, skirt suits or dress pants, nude or black stockings, and leather shoes.
Every doctor keeps the privacy of patients and is centered on patients. There are slideable fabric screen between sickbeds. Doctors talk with patients and perform diagnosis and treatment for patients in a personal space. Everyone prohibits taking the papers or pictures containing patients’ information out of hospital according to British law. All photos can’t contain personal information of patients.
Doctors and patients respect each other and the relationship between doctors and patients is harmonious. A harmonious relationship depends on a better social atmosphere, human-based management, consummate technique and communication skills. The doctor’s attitude is friendly, patient and responsible and patients completely respect and trust doctors because everything is free. Therefore, the obedience of the doctor’s advice is great. Enmity and violence rarely appear between patients and doctors, if any, a guard or a police officer will stop them as soon as possible.
3. Medical Technique Learning
St. George’s hospital, which allows multi-sited license, is a large-scale general hospital. Therefore, senior surgeons have a few practice sites, including private hospitals. My supervisor (Neilson) who is a knowledgeable and optimistic consultant has rich clinical experience and excellent academic level. Neilson focuses on limb fracture and pelvic fracture. He is very busy and has many practice sites, however, he is always smiling and full of energy and everything is in order. His professional ethics and responsibility impress me very much.
The outpatientb needs to make an appointment with the consultant before coming here.The consultant talks kindly with the patient and introduces everyone in the consulting room, especially me. My supervisor tells the patient that Dr. Liu is an observer coming from China. After the patient agrees me to be on the spot, the consultant will start communicating with the patient. The consultant shakes hands warmly with the patient before visiting time and after visiting time. Sometimes, if the patient sits in a wheelchair, the consultant will kneel down on one knee and make eye contact with the patient at the same height, which mirrors its loving heart. The consultant records the medical record by a recording pen and the secretary transforms the record into words and emails it to the general practitioner. The doctor can link some websites to get the newest treatment guideline by ID card or account number. NHS shares the information of all patients in order to avoid repetitive examinations and information loss.
The patients of orthopaedic trauma live in Gunning Ward. The consultant only takes charge of ward rounds, and the attending examines the patient with a nurse, and the junior doctor records patient’s condition. However, the record is very simple and applies a lot of abbreviations. The words of the record can be crossed out and replaced by right words. In the ward, the doctor can look up all reports including CT, MRI and laboratory. The pharmacist and the dietician will help the doctor make treatment plan and rehabilitation plan. The patient is taken care of by nurses and the family can visit the patient over a fixed time period. Therefore, the ward always keeps quiet. The doctor in England performs hand hygiene very well. Quick-drying disinfectants are available everywhere. The doctor needs wearing gloves and apron before touching the patient, and the nurse will remind new comers. But the doctor doesn’t wear a mask in MRSA isolation wards; neither does the observer in operation room. I am not accustomed to that.
The surgery classifying system is very strict. It is definite that the doctors at different ranks can perform different operations. If a junior doctor wants to carry out the surgery he doesn’t perform before, the specialist must guide him. Check is also very strict before starting the surgery, in the process of the surgery and after completing the surgery, and the doctor needs reading the information aloud to make everyone hear clearly. Of the process of the surgery, the surgeon operates very carefully, which makes a clear operation area and less blood loss. Meanwhile, the consultant pays more attention on teaching and encourage junior doctors. After completing a part of the surgery, the consultant guides the junior doctor to complete another part. This is the important reason why junior doctor improves very quickly.
The office hours usually start at 9:00am, but orthopaedic trauma starts at 7:45am, which is the same as our hospital. I don’t know whether the coincidence is God’s will. Every morning, the consultant host a discussion. After the junior doctor reports the new case, including medical history, images and all reports, the consultant will question junior doctors and guide them on how to treat. Eventually, the consultant makes a treatment plan. The whole process is quick and efficient.
4. Life in England
We lived in the hotel inside the hospital which is beautiful and safe. Everyone live alone in a one-bedroom apartment including a bathroom. Four rooms composes a flat, within which tenants share a kitchen including stoves, oven, refrigerator, microwave oven, washing machine, and drying machine. Supermarkets, stores and restaurants locate near the hospital and life is convenient. London is well-known for culture capital and fashion capital. There are a lot of world famous scenery spots, including Buckingham Palace, Westminster Abbey church, Big Ben, British Museum, London Tower Bridge, Florence Nightingale Museum, and so on. On the weekends, we went out for viewing these scenery spots.
Everybody in London is kind and happy to help others. When I didn’t find the station and looked at the road map, someone would ask me whether I needed help. They were patient to tell me how to get to the station. The British have good morals. When taking an escalator, the British stand on the right side of the escalator in order to give space to the person who wants to walk quickly. When waiting a bus or a subway, the British keep getting off and then on and won’t cut line to take a bus or a subway. There are a lot of seats for those who are old, weak, ill or disabled, but normal people sit on these seats.
The experience of study in London is very valuable and I have benefited a lot, including improving my professional technique and oral English, enriching my life experience and broadening my horizon. We need to learn their professional ethics, responsibility and active academic thinking. I will remember all the details of this experience forever. I will do my best to apply what I have learned into my work in the future.