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The Paradocs Podcast

The Paradocs is a fun and lively discussion with a couple of docs on the practice of medicine. Occasionally serious, usually lighthearted, and accidentally informative. A show for physicians to learn more about what is going on and a great place for them to direct their friends and family to better understand the challenges they face.

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 treated appropriately.
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 suffer.
  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.
show notes

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 (NHS).

Episode 002: Dr.Amat describes the reasons why she left the traditional model of practicing insurance based medicine and opened her own direct care clinic.

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 Wible.

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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Listen to The Paradocs on RadioPublic