A tale of two lumps: U.K. vs. U.S.

Sep 10, 2009 4:06 PM

Listening to our president last night, I was reminded of what happened to me as an American living in Brighton, England, several years ago. No, this isn’t a story of medical error and tragedy—it’s just a story of routine health care and two small journeys that give some perspective on what patients go through in England and in the U.S.

I’ve found a lump in my breast twice: In the U.K. four years ago and last year here in the U.S. In both cases, I went to my primary-care doctor and received thorough and compassionate care. But after that, the series of small events highlight the deep flaw I’ve found in the American health-care system.

After finding the lump

U.K.: The nurse practitioner made an appointment for me to go to the special breast unit at my local hospital the next day.

U.S.: I left with a prescription for a mammogram and a list of about 15 imaging centers to call. The next day I made my way through the list, trying to find one that would take my insurance and see me quickly (not as easy as it sounds). In the end I had a choice of three places: one that was nearby but offered a rude receptionist; a second that asked me a barrage of detailed questions I simply couldn’t answer, and left me so frustrated that I burst into tears and hung up; and a third that was far away, but seemed reasonably efficient. I checked all three out on the Internet to find patient reviews. Two hours after making the first call, I put on my thickest skin and made an appointment with the first one to be seen in four days.

The mammogram

U.K.: I showed up at the specialty center and had a mammogram after waiting a half-hour or so. The nurse asked me to hang around while the doctor read the scan. After another hour, the doctor came out and showed me the lump, said they weren’t sure about it and wanted to do a sonogram. After another half-hour, I had a sonogram and needle aspiration.The doctor told me it was a cyst and to be aware that the lump might fill up again.

U.S.: The imaging center was factory-efficient and did many tests and scans (judging by the range of ages and needs of the people waiting with me). I was in and out quickly and the technician said that I’d be called with the results. Two days later I got a phone call requesting that I come back, and two days after that, I had another mammogram followed by a sonogram. I then waited while a doctor in a back room somewhere (who I never did meet) decided what the next steps were. After 30 minutes the receptionist told me that nothing further was needed and that I should schedule a follow-up with my primary-care provider. Ten days later, when I could finally get in to see my doctor, she told me it was just another cyst.

And the winner is?

For me, the U.K. National Health System won hands down. Health care is personal, and frankly, even in my fairly routine situation, it’s all about me. The NHS was clearly more patient-focused, with no insurance speed bumps for any patient to navigate.

Here’s what I took away from both experiences:

U.K.: It took three days to learn I was OK. I found the lump on a Sunday and had resolution on Tuesday afternoon. During this process, though, I didn’t fill out a single form or make a single payment. The details were taken care of for me in a way that required me to do one thing: Get to the hospital on time for my appointment, leaving me free to talk with my family, do some research, and of course, worry.

U.S.: It took three weeks to learn I was OK. Throughout the experience I felt totally burdened. I had choice in the system, but did I really need 15 choices to wade through? And would it have hurt the doctor at the imaging center to actually speak to me (I asked at the time but was told he wouldn’t be available for an hour)? I came away feeling downtrodden—by a system that requires so much of its patients and where you feel like a widget on an assembly line.

The U.S. is on the cusp of actually doing something essential—health-care reform that not only makes sure everyone has coverage, but also refocuses the system on the needs of its patients. If the plan we end up with addresses both of these needs, we’ll all benefit.

—Trisha Brandon, online editor

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