Students Compare British and American Health-Care Systems

“Amazing,” “fantastic,” and “mind-blowing.” That’s what students say about their experience in the London-based course Ethical and Social Issues in Health Care in the U.K. and the U.S.

Led by Stephen E. Lammers, Helen H.P. Manson Professor of the English Bible, and Alan W. Childs, professor of psychology, 22 students traveled to England May 16-July 2 to compare social, ethical, and cultural aspects of health-care systems in the United Kingdom and United States.

Each week they worked four days as interns in a wide array of British health-care institutions. On the fifth day they met in class to discuss their experiences and observations.

“Honestly, this was one of the best things I’ve ever done in my life,” says neuroscience major Siobhan Pattwell ’06 (Middletown, N.J.). “First of all, I had to balance going to work full-time every day and attending a class – which we had plenty of work for – with getting out and exploring the city and culture. If nothing else it taught me about time management.”

But Pattwell quickly emphasizes that she learned much more than time management. During her internship she shadowed a pediatric oncologist at Great Ormond Street Hospital, the renowned London facility for children with chronic and terminal illnesses.

“Nothing in my life could have prepared me for looking parents in the eyes and telling them we were going to stop treatments,” she says. “The compassion I learned for people was more than I ever could have learned doing anything else – especially if I go into the field of medicine and research, I don’t think I would ever have grasped how the drugs influence people. You can read about people being uncomfortable because of the medications, but to actually witness it first-hand is something you cannot get from a book.

“It may sound corny to say it was a life-altering experience, but it was. It just blew me away.”

Though very different from Pattwell’s, the internship served by Peter Winsky ’07 (Medford, N.J.) was also life-changing.

A government and law major, Winsky worked for a nonprofit advocacy group, the Association of Medical Research Charities. He gathered data from universities that conduct medical research on how they spent money given by charitable organizations and whether they recorded their expenditures.

“The head of my organization was invited to an informational gathering at Parliament, and she decided it would be a good experience for me to come along and talk to with people at the function because it was held by an organization similar to ours,” Winsky says. “She also thought it would be good for me to meet some members of Parliament.

“It was fantastic – unbelievable and overwhelming – to see things that almost no one gets to see. At one point my boss left me, and I felt really awkward being the only American, and probably the youngest person, in the room. But I had a rather long conversation about America with a lord and felt I held my own pretty well.”

Students also interned at dental clinics, veterinary clinics, hospitals, physical therapy centers, schools (including a school for deaf children), and charitable organizations.

Childs and Lammers developed the course. They say it has been immensely rewarding to watch students come to understand and appreciate the complexities involved in the delivery of health care under any system.

“Certainly this will make them better practitioners, if that’s the direction they go, but also better consumers, even if they have nothing further to do with health care,” Childs says. “It makes them understand how the political and economic systems work in their own culture.”

Insights come quickly and powerfully, Lammers says.

“Many students come to the course with the presumption that America has the best health-care system in the world. They learn that we have the best health care technology, but that in terms of outcomes – using measures like infant mortality, all mortality, and morbidity – many other health-care systems do better than America,” he explains.

“Further, they do this spending a lot less than we do. We have the best health care system for persons with lots of money, but we do not focus on the health of the overall population, which is how health care is done in Britain.”

There is an irony in this, Lammers notes. It could be argued that British culture is not as health conscious as that in America. There certainly is more smoking in Britain, for example. Yet in the less health-conscious British culture, health outcomes are better.

“All health-care systems are currently facing enormous challenges,” Lammers says. “Hopefully, those students who chose to work in health care will have learned to look at a lot of different health-care systems when trying to solve the problems that they will encounter in the American health-care system.”

Winsky says, “I knew almost nothing about socialized health care, which is what England has, and very little about private health care. The course really helped me form my own opinions, not just about the health care system here, but also about how our government works and the way people in this country think about health care.”

The bulk of the students’ discoveries occurred outside the classroom, Lammers says.

“They start to notice differences in the ways medicine is approached and in people’s expectations. They have to be in the midst of it to see it, and all we do is facilitate it by probing them with questions,” he says. Winsky agrees.

“In England I had direct relationships with people in the system that I was learning about in class,” he explains.

It’s one thing to read in a book that 45 million Americans are uninsured or talk with his father about how much he has to pay for health care, he says.

“But to understand how the English live and function under a completely different system, it really helped to be able to talk with a co-worker who has lived it about his experiences and feelings on the benefits a newborn receives. You get the first-hand experience as to how people actually cope with a system that’s not your own, as opposed to learning about the benefits in class and wondering,” Winsky says.

The professors hope and expect that some of the class members will attempt to effect changes in health care in America and beyond. Patwell has already made an impact. She helped conduct a study aimed at identifying the number of children receiving chemotherapy who lost their hearing.

“Doctors noticed that children receiving one of the most deadly chemotherapies experienced a profound hearing loss, and some went completely deaf,” Pattwell explains. “Not hearing is a huge disadvantage for children who are cured, but it’s just as damaging for children who are dying not to be able to hear their parents say, ‘I love you.’”

So Pattwell and British audiologist Wendy Albuquerque gathered data on pediatric chemotherapy patients in hospitals around the world.

“We found that a lot of hospitals aren’t doing a very good job of monitoring hearing loss. We took our report to a conference in Vienna, and there were pediatric oncologists there from all over the world,” Pattwell says.

Regardless of whether they eventually enter the health-care field, experience abroad makes students more mature, well-rounded individuals, Childs feels.

“It gives them something very interesting to talk about when they go to graduate school or job interviews,” Childs says. “I think they can now speak with great sophistication on how health care can work and how there could be some solutions learned from the comparative situations they had.”

Winsky says the trip taught him a lot about himself. “Simply living abroad by myself made me feel more capable. “There I was, working, going to class, making sure everything went the way it needed to. I became more independent. It helped me get ready for the future.”

Pattwell also gained perspective on her future. Comparing British women health-care practitioners’ maternity and vacation benefits with those of Americans made her less keen on entering the field, she says.

“I don’t think that I would prefer the lifestyle of a doctor in America,” she says. “The British women I worked with get five weeks of paid vacation a year and one full year of maternity leave, and day care services are provided and paid for. But in America there’s none of that. My ob-gyn just had a baby and told me she wants to take a year off, but as she’s 32 and has only been practicing for a few years, doesn’t want to put her career in jeopardy.

“Also, the class showed us how the paperwork doctors have to do substantially limits the time they have with patients,” Pattwell continues. “I do want to do something related to medicine and science, but on the research or clinical level.”

Pattwell is a member of Spanish Club and Delta Gamma sorority, plays intramural flag football, and participates in volunteer activities throughout the year.

Winsky is a member of the club hockey team, DJ for WJRH, and historian for his fraternity, Phi Gamma Delta.

Lammers is coeditor of On Moral Medicine, an award-winning book in medical ethics, and Theological Voices in Medical Ethics. He is the recipient of Lafayette’s Carl R. and Ingeborg Beidleman Research Award, which recognizes excellence in applied research or scholarship. Lammers is ethics consultant for Lehigh Valley Hospital and Health Network, working with residents and medical students, and a member of the hospital’s Institutional Review Board, Institutional Animal Use and Care Committee, and Ethics Committee.

Childs is former chair of the College’s Health Professions Advising Committee. He is the recipient of several Lafayette awards for excellence in teaching, including the Student Government Superior Teaching Award, Marquis Distinguished Teaching Award, and James P. Crawford Award and Lafayette’s Daniel Golden ’34 Award for service. The faculty mentor for the men’s basketball team, he served as founding executive director of the Colonial League, the predecessor to Patriot League. He is a former American Council on Education Fellow.