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PT and the Greater Good

The honeymoon is over

Published April 1, 2010 4:55 PM by Dean Metz

I've been working in the NHS now for 5 months now and living in the United Kingdom for 6. Some days it feels like it took 5 years to get through the past 5 months. Back in New York, I knew the ins and outs of Medicare and Medicaid, I knew how to get through a JCAHO survey with flying colors (and did for 3 different agencies!) and a DOH audit is no sweat. In essence, I had nearly 2 decades worth of experience that meant something. I feel like an idiot here.

I keep floundering into walls, errors, and miscommunications here. I keep applying a USA mindset to things and find out that what I thought was a logical connection is, in fact, the wrong way of doing things. I have to remind myself that I have had no Physiotherapy mentor through this process. The person who was supposed to have that role is the one who had also applied for my position...and didn't get it. To say they have been unhelpful would be more kindness than they deserve.

The bureaucracy behind things that used to be so simple back home is mind boggling here. Yes, the NHS does make CMS look simple to navigate! I wanted to order a hemi-walker for a client. The equipment stock doesn't normally carry them, the non-mentor therapist had never heard of one, and nobody knew what I was talking about. I found one through a DME company, ordered it with manager approval, it worked and the client is now an independent community ambulatory! The time frame for this process was 3 months. More forms than I care to think about and I've learned that I still may not have followed the correct protocol.

I'm tired of being misunderstood. I can't use "rhonchi" when describing breath sounds, they are "coarse".I can't use "extremity" when referring to an arm or leg. I say musculoskeletal instead of musculoskeleeeetal. There are days I feel like a global aphasia has set in.

I know I'm feeling blue when completing an OASIS sounds appealing! Fingers crossed, next week will be better.

posted by Dean Metz

3 comments

Hi Dean,

Just wanted to drop a line to say that I have been following and enjoying your blog from day 1. I'd like to think that I have a special understanding for what you have been going through, as I have been having a very similar experience, only I moved from the UK to the USA 5 months ago.  (A little background information - I am South African trained and have actually also been through the process of moving and getting licensed in the UK a few years ago!)

My frustration with everything from emmigration paperwork and visas to getting licensed as a PT in the USA (a much more complex process than getting licenced in the UK!) and now feeling like a 'beginner' in a profession which I have been practising for 15 years. The documentation is foreign, terminology different, names of medications confusing...

Love the blog, please keep it going!

Mareli Klopper, Physiotherapist April 21, 2010 11:28 PM
Lake Charles LA

Hi Derek, thanks for taking the time to read my blog! Like any new post, at about the 6 month point reality sets in. Yes, I am frustrated. That frustration generally comes from still feeling like a foreigner in a field I was so very comfortable in back home. There is bureaucracy here, lots of it. That is frustrating too, but not because it exists, I just don't yet know how to "play the game" like I did in the US. In the US, I knew what information CMS and managed care companies wanted from me so that I could go on providing my patients their necessary treatments. I knew what the Milliman guidelines were so I could work within them.

I still don't have that knowledge here. Imagine you're playing a sport, any sport, with a defined set of rules and suddenly that rule book is thrown out and a new one is issued. That's the best analogy I can think of for what I'm feeling right now.

You have valid concerns about the changes coming, I think it is still rather unclear what the changes are really going to mean to practice. However, I must say, the US system is not better than the UK. Different of course, but not better. With managed care, the rationing of healthcare already exists in the USA. If one doesn't have insurance, up until a few days ago, one wouldn't necessarily get decent care. As I wrote in an earlier post, my mother lives in Sarasota, not far from you. I see her struggle with an impossible Medicare and managed care combination that would test the patience of Job.

I had an interesting experience the other day. I had a patient who would've been considered a VIP back in New York. It was made very clear to me that this person would not have any different care just because of who they were. They would have the care they needed, but no "extras".

As for the US healthcare system being the best in the world, a recent survey of the developed nations which looked at infant mortality, average life expectancy, and prevention of chronic illness, the US was found to be number 38, not number 1. I am simultaneously studying for my Masters in Public Health at a University in Florida. That program has really opened my eyes as to what constitutes a good healthcare system.

The UK system is flawed, without a doubt. So is the US system. Do I know what the best system would be? No way, not yet anyway. But that is part of why I'm here in the UK and part of why I'm studying in Florida. I truly want to be part of the solution to the problem.

Dean Metz April 3, 2010 4:56 AM

As I read, progressively, your comments and articles from first to most recent, am I correct in saying that you are coming to believe that the UK system may not be so hot?  Based on what you have seen and experienced in the UK, what are your thoughts on the changes to our US system currently being put in place by the Obama Administration?  %0d%0a%0d%0aI am very fearful that the US System is about to be relegated from the best in the world to simply mediocre, primarily because of the horrific bureacracy we all know is coming.  I really do not like what I am reading and witnessing......

Derek Brock, Home Health - Rehab Director April 2, 2010 8:36 AM
Naples FL

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About this Blog


    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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