"When you go to the doctor feeling sick you spend time cooling your heels, first in the waiting room and then again sitting in a flimsy gown, on an examining table. Finally the doctor rushes in , pausing only long enough to ask a series of questions on a checklist before dashing out again to see the next patent. if the doctor refers you to a specialist, getting an appointment takes weeks. if the doctor prescribes you a drug, your insurer refuses to pay for it."
So wrote Shannon Brownlee in her book "Overtreated" - I was Recommended the book by a colleague who had spent a fair chunk of his career living and working in the states, not as some prized international guest but as a jobbing Doc, who saw the system from the inside, the old, the bad, and the ugly.
So why the fascination with America?
Is it the prospect of visiting a system in which every latest test and treatment is possible? ( insurer permitting). Is it the possibility of seeing what happens when you are in track to spend 20% of your GDP, the equivalent of the total budget of Italy, on healthcare?
I suspect it is because we in the NHS are foolish enough to believe the hype, the media, the spin that says America has it right, is sorted, is the way forward.
Ok, I accept there may be pockets of answers in the states, perhaps accountable care organisations have something to offer, perhaps safety initiatives can be transferred across the big pond. However I would also suggest that we have much more to learn from Europe, where primary care is more like our own, where health issues, financial mechanism and political environment offer more transferable solutions.
If you must look across the pond, why not try the other great nation on the continent of North America? -Canada.