Virginia to Glasgow - Neurology Across the Pond

 
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Virginia to Glasgow - Neurology Across the Pond

 

interior or hospitalGlasgow sceneryAndy by the sea Andy and Leah at AAN Hospital exteriorSailboats in Scotland

 

Background

  • The Institute of Neurological Sciences in Glasgow, UK is one of several specialty facilities at the Southern General Hospital, a subsidiary of the NHS Greater Glasgow and CLeah with M. Farrugialyde comprising some 900 beds
  • Southern General is a teaching hospital that provides Neurological, Neurosurgical, Clinical Neurophysiology, Neuroradiological, and Neuropathology services for the West of Scotland
  • The National Health Service (NHS) was founded in 1948 and has grown to serve the people of the United Kingdom as the world’s largest publicly funded health service (> 60 million people)
  • Funded centrally from national taxation, but managed separately in England, Northern Ireland, Scotland and Wales
  • Only the Chinese People’s Liberation Army, the Indian Railways, and Wal-Mart employ more people  
  • 2008-2009 budget exceeded £100 billion - £1,980 per person  (1948 budget - £437 million)
  • 80% of funding distributed by local trusts to meet the health priorities of the area

 Purpose 

  • Expose trainees to the practice of neurology in the NHS system of care
  • Exchange ideas regarding neurology training and standard of clinical practice between institutions
  • Explore avenues for collaborative research

  • Establish a foundation for future exchange

Teaching and Experience

  • Rotation divided into a variety of outpatient and inpatient experiences in ccastleonjunction with registrars
  • Muscle Clinic, Headache Clinic, Stroke and TIA Clinic, and General Neurology Clinics (in addition to rural outreach clinics)
  • Attended daily conferences, multidisciplinary rounds, neuroradiology conference, and provided grand rounds
  • Rotated on inpatient wards with multiple teams including stroke service (medicine for the elderly) and professor rounds on the general neurology services
  • Discussed differences, strengths, and weaknesses of respective systems of care from multiple perspectives including physicians, registrars, staff, and patients

 Future Directions

  • Broaden experience to include multiple hospital exposures in Glasgow and the surrounding are
  • Expand exchange program to include neurology registrars interested in rotating at UVa
  • Explore avenues for additional funding support
  • Coordinate invited lecturers and professors
  • Collaborate with the UVa School of Public Health Sciences to formalize education of other systems of care

 Reflections from Residents

Andy SoutherlandAndy by bridge cropped, MD

“While the differences in our respective healthcare systems are striking, the fundamental similarities lie in the hills and valleys of treating neurological disease.”

“I was impacted by the general appreciation and contentment of patients.  Although resources and options are more limited in many cases, there was less sense of entitlement and more an expression of gratitude for the healthcare received.  This cultural difference also seems to limit socioeconomic barriers between patients.”

“When advanced diagnostic tests are not immediately available, the importance of the bedside neurological exam is underscored.”

Leah Acosta, MD

Leah on tpo of peak“Overall the British seem quite satisfied with their health care and wonder why the US does not implement the same. One striking point raised by one individual was that if health care was as important as, say, education is for everybody, then why doesn’t the government underscore this by providing health care.”

“The British also seemed to be appreciative of their health care when I could easily surmise they might feel entitled since health care is free.”