Would it surprise you to know that there are significant differences between the American and British health systems?
Didn’t think so.
Here are the differences most likely to trip up Americans:
I am no expert: I’ve never lived in the UK, and I’ve only visited the sceptred isle once and for a short time. I am certainly not going to try to tell you what is “British” and “not British.”
What I am attempting to do is alert you to things you might want to think about when you, a distinctly non-British person, are writing Harry Potter (or other Britain-based) fic.
These are things that have tripped me up as an American attempting to impersonate a Brit when I write. (And please take everything here with a large grain of salt—again, I am emphatically not an expert. If you are, and you think I’ve made an error, please give me a shout.)
One of the biggest mistakes Americans make when writing fic that brushes up against the British medical system is that, generally, British people don’t struggle to pay their healthcare bills. At least not for basic medical care. My American friends will be shocked to learn that there really is no such thing as “medical bankruptcy” in Britain. (British friends, Google the term and weep for us.)
The UK has universal healthcare. British citizens and other eligible residents are covered by the National Health Service (each country has its own flavor) which is funded by the government via taxes. Benefits are comprehensive, and many services are free to patients. Generally, no one goes without care for financial reasons, and people don’t go into debt or start GoFundMe campaigns to pay for care. Weird, right?
The following services are free under the NHS:
Yes, my fellow Americans, you read that right. There are no copayments, “co-insurance,” or deductibles for these services under the NHS.
There is some payment required for the following services (though the prices will be much lower than in the US):
Medication
In England, there is a fixed charge (currently £9.90 per medication) for prescriptions up to a three-month supply, with certain exemptions, including contraception and medication for hospital inpatients. Some groups are likewise exempt from the prescription medication copayment, including: children under age 15 and full-time students up to age 18; people age 60 or older; individuals with low incomes; people who are pregnant or who have given birth in the past 12 months; people with certain disabilities or conditions like cancer. (In Northern Ireland, Scotland, and Wales, there are no charges for prescriptions.)
Dental Care
Dentists who contract with the NHS can only charge NHS-set rates; not all dentists in the UK are contracted with the NHS.
Vision Care
Vision care and optical services are subsidized under the NHS, with free eye exams for children and those over 60, and people with certain eye conditions. These exams are provided by ophthalmic medical practitioners or optometrists, who can refer patients to ophthalmologists or other physicians when necessary. Those eligible for free eye exams may also receive vouchers to pay some of the cost of corrective lenses (glasses or contacts).
Those not eligible for the NHS can still receive care at NHS facilities, but will pay for some portion of services, although the costs are far lower than in the U.S.
A significant portion of Brits also purchase or receive employer-sponsored private insurance, which can pay for facilities, providers, and services not covered by the NHS.
One of the biggest reasons for using private insurance in the UK is reducing the waiting time that sometimes afflicts the NHS for non-urgent, high-demand services (e.g., hip replacements). Private facilities (and private-pay units within NHS facilities) also tend to have more amenities than NHS, including private rooms.
Medical students in the UK typically begin their training right out of secondary (high) school, with a five-year medical program (may be accelerated to four years or extended to six years, depending on circumstances), followed by a two-year “foundation” programme where they study general medicine and general surgery, and may study additional elective specialties.
After completion of the foundation programme, doctors in the UK can elect to become general practitioners (GPs) or undergo additional “on-the-job” clinical training in another specialty. GPs undergo approximately three years of this additional training, while other specialties require a further five to seven years of training.
The cost of medical school is considerably lower in the U.K. than in the U.S., with the government capping tuition at less than £10,000 per year for British students in public universities (fees for international students can be much higher) in England and Wales (Northern Ireland and Scotland differ somewhat). Medical programs in private universities may charge more. The government offers loans to defray tuition and living expenses. As in the US, there are additional fees for exams, licensing, and professional development.
Most doctors in the UK work directly for the NHS. Some may also take private patients. UK doctors tend to earn significantly less than US doctors, but as in the US, salary depends on specialty and level of experience and expertise.
As in the US, the UK has registered nurses, who staff hospitals; nursing associates (nursing assistants), who provide care such as washing and dressing, feeding, or basic assessments such as vital signs, etc.; midwives (nurse-midwives/CNMs), who attend uncomplicated births in hospitals and in homes; specialist/advanced practice nurses (nurse practitioners), who have additional post-graduate nursing training and can run clinics and provide specialist nursing care in the community or in hospitals.
Senior nurses (similar to charge nurses in the US) in hospitals are sometimes called “sisters” or “nursing sisters,” because historically, nursing care was provided by nuns.
UK residents receive an NHS number—this is a 10-digit number assigned at birth or the first time a person receives NHS care.
Most people will register with a GP to receive routine primary care, which is required to receive care in the NHS. To see a specialist, patients generally need a referral from their GP.
People with private insurance or who are prepared to pay out of pocket can see specialists outside the NHS (although they will often have a GP within the NHS), which can be faster than waiting to see an NHS specialist. (The target wait for a specialist under the NHS is 18 weeks or less, but the reality varies depending on demand, specialty, and location.)
As in the US, the UK has urgent treatment centers for urgent but non-life-threatening conditions. For emergency treatment, people go to the A&E department in their local hospital.
As with everything else, terminology related to healthcare differs between the US and the UK.
UK Term | US Term |
“Mr./Miss” – traditionally, in the UK, a surgeon is called Mr. or Ms. rather than Dr. | “Dr.” (surgeon) |
Anaesthetist (doctor) | anesthesiologist (US also has nurse anesthetists—certified registered nurse anesthetists, CRNAs) |
Consultant | Roughly equivalent to an attending physician in a hospital |
Foundation doctor/pre-registration house officer | Roughly equivalent to an intern/PGY-1 |
General practitioner (GP) | PCP/internist/family medicine doctor |
Matron | Chief nursing officer |
MB/BCh (Medical Bachelor/Bachelor of Surgery); MD in Britain is a doctorate awarded after at least 2 years of pure medical research, roughly equivalent to a PhD | MD |
Physiotherapist | Physical therapist |
Registrar/junior doctor/resident doctor | Roughly equivalent to a resident/PGY-2+ |
Senior doctor (able to practice independently without supervision) | doctor |
Sister/ward sister | Charge nurse |
UK | US |
Adrenaline | Epinephrine |
Appendicectomy | Appendectomy |
Band-Aid | Plaster |
Bowel opened (BO) | Bowel movement (BM) |
Crash call/arrest | Code (code blue) |
Creps/rales/crackles | Crackles (lung) |
FBC/FHG (full blood count/haemogram) | CBC (complete blood count) |
Fit/fitting | Seizure/seizing |
Glandular fever | Mononucleosis (mono) |
Ill | Sick |
Jab | Shot |
Medicines | Drugs |
NBM (nil by mouth) | NPO (nil per os) |
Observations | Vitals (vital signs) |
Paracetamol | acetaminophen |
RIG (radiologically inserted gastrostomy) | g-tube (gastrostomy tube) |
Ryle’s tube (Ryle) | NG tube (nasogastric tube) |
Sick up | Throw up |
Tablet | Pill |
U’s and E’s (urea and electrolytes) | BMP (basic metabolic profile) |
UK | US |
999 (emergency telephone number) | 911 |
A&E (Accident & Emergency)/casualty | ER/ED |
Bleep, bleeper | Beep/page, beeper/pager |
Chemist | Pharmacy/drugstore |
Emergency/resus trolley | Crash cart |
HDU (high dependency unit) | Stepdown unit |
Specialism | specialty |
Surgery | Clinic |
Theatre (operating theatre) | OR (operating room) |
Trolley | Gurney |
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