Glasgow, Scotland
Glasgow Royal Hospital for Children
April 2-27, 2018
I participated in a 4-week international elective at the Royal Hospital for Children in Glasgow, Scotland. This elective took place April 2-27, 2018. I spent two weeks in the PICU and two weeks in the pediatric A&E department (their emergency department). My main goals during this elective were to see firsthand how the differences in the healthcare systems between Scotland and the US play out in practice from the perspective of medical student/physician. I also hoped to see a different patient population and get a sense of the unique medical issues that affect Glasgow, which is known to have particularly bad health outcomes.
Scotland’s healthcare system is called the NHS, which is a system in which everyone is guaranteed healthcare from birth to death. It is paid for through taxes. There is no private insurance at all, which is in slight contrast to England’s NHS, which has some private components. In contrast with this seemingly idyllic health system for all, Scotland has one of the lowest life expectancy levels among countries within the EU. Glasgow specifically has the highest mortality rates in the UK, and is among the highest in all of Europe. As mentioned above, with this project I was hoping to gain insight into the day-to-day workings of the NHS and how it affects medical practice in Scotland. I was also hoping to see the unique health issues that may affect the children of Glasgow.
Working at the Royal Hospital for Children in Glasgow was an incredible experience because it is one of two hospitals in all of Scotland with a pediatric intensive care unit, and the only hospital in all of Scotland that provides certain complicated services for children such as bone marrow transplant, organ transplant, and is considered the national pediatric cardiac service. As a result, the patient population the hospital serves is extremely wide-ranging and diverse.
Aside from the widespread geographic distribution of the patient population in the PICU, it seemed to function very similarly to the PICUs we have in the US. A&E, (“Accident and Emergency”), their equivalent of an ED, while it functioned similarly, is where I noticed more differences. What I found very interesting about pediatrics in Scotland’s healthcare system is that there is really no such thing as a general outpatient pediatrician. Everyone is assigned a GP, a physician they see from cradle to grave. The GP training can vary drastically, and many GPs did not have much pediatric experience during their training. As a result, many GPs send children into A&E for problems that we’d often see managed by general pediatricians in the US. It surprised me how many children presenting with pretty standard, non-concerning viral illnesses were referred from the GP to A&E.
In A&E, I encountered a huge spectrum of levels of training, everyone from medical students, to emergency nurse practitioners, to consultants (their equivalent of attendings) are routinely seeing patients. In the PICU, I participated in morning rounds, and then was able to observe and assist in various minor procedures including lumbar puncture, extubations and intubations, and even spent one day in the “theatre” (aka operating room for a PA banding procedure. In A&E, I picked up patients as they came in, taking histories and examining them, and presenting to the trainees or consultants.
This experience definitely opened my eyes to unique workings of the NHS. It is incredible that everyone in Scotland automatically gets healthcare throughout his or her entire life. However, the system is not without its problems. In A&E we had one adolescent girl come in with chronic abdominal pain. She had been seen by her GP and was referred to A&E for this issue. I questioned why they would refer her to the emergency department for this non-emergent, chronic issue, as opposed to referral to a gastroenterologist. I was told that because waiting lists to see pediatric GI are so long, often GPs refer their patients to A&E because it allows them to bypass the waitlist because once in the hospital, GI can be consulted to see the patient immediately.
The best aspects of the experience were taking care of such a wide-ranging and unique population in a huge, tertiary care children’s hospital that serves the entire pediatric population of Scotland. I really enjoyed working in A&E, where I had the experience of seeing patient cases through from start to finish, and acting as one of their primary care providers. I remain curious about how outpatient pediatrics functions in Scotland, knowing that there are no general pediatricians and that there is an apparent shortage of pediatric subspecialists. As someone going into pediatrics, the idea of a general pediatrician is so central to child healthcare that it is difficult to imagine that practice not existing. I was able to see how it may affect the hospital system, but would love to know more about how it affects outpatient pediatrics. For students interested in doing a similar elective at the Royal Hospital for Children in Glasgow, I would highly recommend it!