Sep 4, 2019
Debate rages in the United States about whether we should
alter our medical system gradually. Or maybe adopt a health system
like the NHS of the UK. Unfortunately, it is difficult to find
people who can honestly talk about what it's like working as a
doctor in the NHS and the US medical system. However, I have the
great fortune of speaking to someone who can speak on authority
working as a primary care doctor in both.
Dr. Clodagh Ryan is my guest this week. Dr. Ryan is native to
Ireland where she did medical school and training in family
medicine. She practiced as a primary care doctor (GP) for a few
years in Ireland. There she worked within the UK's NHS (in
Northern Ireland) and the Irish national health system.
She then emigrated to the United States where she completed a
family medicine residency. She practiced family medicine in a
traditional insurance-based practice for 8 years before opening up
her own direct primary care practice.
Because of her experience working within all these systems,
she is the perfect guest to contrast and compare how the health
systems work. Dr. Ryan also has most of her family still in Ireland
so she can comment about what the system looks like through the
lens of a patient too.
Not surprisingly, there are concerning things to be considered
all these medical systems. The primary concern that struck me most
was that she believes there is more suffering in the UK and Irish
health systems because of delays in treatment. Sometimes this just
means 12-24 hour waits in the ER if you don't have a life
threatening condition like a broken bone. Other times, you have to
find ways to deal with pain and illnesses that take months to be
However, there are some aspects of the system that are better
like more compact notes instead of the gigantic data monstrosities
that today's US EHRs produce. And then there are some things that
look similar to the US system. These include fighting
administrators to get tests or imaging done just like we fight
insurers for prior authorization.
Perhaps the most disappointing aspect of health care in
Ireland and the UK is the inability for people to develop different
ways of delivering care. In the US, direct primary care is becoming
more popular as both patients and physicians see the value of this
innovation. Rigid top down systems of delivering care managed
through national budgets and decided by politicians squashes
innovation. Therefore, patients and physicians both
Dr. Clodagh Ryan is native to
Ireland and a family practice physician. She currently owns and
runs Cara Direct Care medical clinic in suburban Chicago.
Cara Direct Care:
Dr. Clodagh Ryan's direct primary care practice in La Grange,
Illinois (suburban Chicago).
Episode 053: Dr.
Philip Booth speaks about the UK's National Health Service
Dr.Amat describes the reasons why she left the traditional model of
practicing insurance based medicine and opened her own direct care
Episode 030: Physician
suicide and burnout are a problem in the UK and Ireland too. This
is the discussion I had with physician suicide expert, Dr. Pam
YouTube for Paradocs:
Here you can watch the video of my late son singing his solo on the
Paradocs YouTube page.
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