From: [log in to unmask]> Throughout my career I have worked in Florida and Illinois
--> I have spent many vacation weeks in Florida. I am writing from Florida right now, actually (flying back to the UK tomorrow to see some snow). I also spent a couple of years being "in Florida" each week as a cruise doctor.
Never been to IL yet. It's a plan...
> I likely have seen about 5-10 Canadian patients per year, a few from Dubai, a few from the Netherlands, a few from other parts in the world.
--> Where I currently work in the UK, I don't get this, but I did when I worked in Central London for a number of years, at some of the more famous hospitals...;-)
> This is in no way scientific obviously by any means
--> You're very right. This was one of my points. We should stop setting ourselves images/standards/targets/goals which drive expectations beyond what our MEDICAL mind tells us...
> ...every foreign patient notes there healthcare in there country is no where near as good as the healthcare we provide
--> First, then, you must be congratulated on working at a place which gets such compliments. As we all know, complaints do happen in ED (I don't just mean ones which are aimed at litigation) so it's really pleasing to receive good feedback.
I can tell you that, from recall, when I worked, for example, at St. Thomas Hospital in London, directly across the Thames from the Houses of Parliament, I saw many Americans, Canadians and other-ians. Even there, I could not say 100% of my foreigners gave such praise, although we were close to 100%. Still, this was many years ago, before surveys and the like...
When I went to Dubai only recently and visited one of the facilities there, wehre a friend of mine works, I saw an ED which compares perfectly well with ANY Brit/American one. It has all the modern stuff and it also has physicians from the USA, CA, UK and local, so this is not surprising. Maybe the Dubai patient you saw goes to another ED in Dubai or else they might have said they DID have something as good...
I think the point which many have hinted at is that not all patients get to go to places like yours, or this one in Dubai or some of the more impressive London EDs...
> These are typically well to do patients as well...
--> This brings us nicely to the crux and I would like you to accept that the points I make below do not arise from disputing any of the good feedback you have described above, which I am certain was well-earned by your ED.
Healthcare system quality is NOT well-represented by the EM care received by a WEALTHY TOURIST in an AFFLUENT POPULAR TOURIST AREA like Florida or London. There's much more in the pie chart from primary care, rural areas, single-income-young-couples-at-minimum-wage, multi-pathology-chronic-patients-with-under-insurance, etc... It's THESE people who drag the average down for the USA, despite there being some really shiny stars in it, like your ED.
And another thing which further downgrades the quality of the statistics is when we use the opinion of patients about quality. They are really insufficiently trained in assessing quality and often focus on the wrong attributes, e.g. rating a "nice" doctor above a good one, a short wait above an effective first-time diagnosis, a well-decorated high spec venue above one with better surgical outcomes or, as more and more we hear these days, they LOVE places with good visiting hours although these may come at the risk of more infection spread. A nice carpet and lick of paint may well put one place above another, despite the latter being actually better when professionally assessed.
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