We need to be more pragmatic

doi:10.1136/bmj.39423.425174.1F

BMJ 2008;336:8-9 (5 January), doi:10.1136/bmj.39423.425174.1F

Letters

Health care and markets

We need to be more pragmatic

The first 150 words of the full text of this article appear below.

I worked for two years as an attending physician at the Universityof California, San Francisco, and the past 12 years as a consultantin the NHS. Rampant commercialism in health care doesn’twork well,¹ ² but nor does health care by slavish social dogma,as in the United Kingdom.

In my experience in the United States, university medicine wasof a high calibre; knowledge and procedural skill levels werethe best I have encountered, and patients were treated as individualsand routinely attended by a specialist every day, somethingthat is unheard of in the NHS. Politics of a parliamentary orhospital kind were subservient to care.

Before I went to the US, the NHS was lean and efficient andserved the sickest patients in greatest need first, with anexceptional standard at reasonable cost, albeit with long waitingtimes for elective care. In the 12 years since I got . . . [Full text of this article]

Adam Paul Fitzpatrick, consultant cardiologist

¹ Manchester Royal Infirmary, Manchester M13 9WL

adam1@maxwellton.me.uk

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