By Moriah Pollock-Hawthorne HC ’15
Immediately after completing the last exam of my junior year at Haverford, I boarded a plane to London to begin a six-week internship in which I would learn as much as I could about the inner workings of England’s National Health Service, a single-payer healthcare system. Dr. Amanda Adler—my generous host and the diabetes specialist who would act as my teacher and mentor during my internship—met me at Heathrow International Airport and drove me to her thatched cottage in Fowlmere, a sleepy little town in the English countryside about ten miles away from the hospital in Cambridge.
As I got settled in, Dr. Adler and I laid out the schedule for the next six weeks that would fulfill the goal of my internship, which was to experience the National Health Service [NHS] in action, from the creation of health care guidelines and policies to their application in clinical settings.
For four weeks, I directly experienced British health care by shadowing and assisting Dr. Adler and her colleagues as they ran various clinics at the Institute of Metabolic Science at Cambridge University’s Addenbrooke’s Hospital. During this time I observed a diabetes clinic (where new and regular patients with all types of diabetes came in for routine check-ups), an endocrine clinic, a diabetic foot clinic (where I first saw gangrene, NOT a pleasant sight), a cystic fibrosis and diabetes joint-clinic, a diabetes and renal failure joint-clinic, a pre-conception counseling clinic, and a diabetes clinic for pregnant women.
The time I spent in clinic really inspired me and made me certain that I want to work in clinical medicine when I become a doctor. It was amazing to meet all of the British patients and hearing their stories about their diabetes and how different treatments affect their daily lives. For example, one patient was greatly relieved when the doctor agreed to lower her dose of insulin because until that point she had become so terrified of having a “hypo”—a dangerously low blood sugar—that she could not even leave her house. By listening to patients I learned much more about diabetes than I could have ever learned from a textbook and from their stories I learned a lot about British culture and daily life in England.
During the four weeks I spent in clinic, I got hands-on clinical experience crucial to the preparation for my future career in medicine, learned a great deal about diabetes, and got to experience first-hand how the NHS works in the clinical setting.
For the other two weeks of my internship, I moved down to Dr. Adler’s flat in London. The goal of this part of my internship was to learn about the processes in which the health policies and guidelines used by doctors in the NHS are created. To do this, I observed a technology appraisal meeting chaired by Dr. Adler, who works part time with the National Institute for Health and Care Excellence (NICE), a non-profit organization that creates guidelines and policies for the NHS to ensure affordability and standards of care for medicine. To further explore the field of health policy, I also worked for two weeks as an intern for NICE International in London, a small semi-autonomous branch of NICE that applies the experiences of NICE and the NHS to help developing countries in the formation of principles, priorities, and guidelines as these countries begin to create or expand their own healthcare systems.
During my time at NICE International, I commuted to work on the Tube like a true Londoner and used my PowerPoint and Excel skills to assist the team as they prepared a presentation for a big meeting, which I had the privilege to attend. During this meeting I (representing Haverford) sat around a table surrounded by incredible people who work for exceptional organizations—such as Bill and Melinda Gates Foundation, World Bank, Rockefeller Center, Center for Global Development, and the UK’s Department of International Development. I listened intently as they discussed the best way to aid low and middle income countries in the establishment of priorities and guidelines for good quality health care and debated which country (or countries) they should choose for the trial run of their new program—the International Decision Support Initiative. I also got to attend the launch party for this initiative at the House of Lords in British Parliament!
As my internship came to an end and I prepared to return to the United States, I realized just how much I had learned about diabetes treatment, clinical medicine, and how the NHS operates and serves as an inspiring example for developing countries around the world. One of the experiences that struck me most during my time in England was the reaction of utter surprise and shock I received from the English people when I said to them, “You are so lucky to have the NHS! In the United States, many people experience constant worry and stress that they will not be able to afford the medical attention they need to maintain their health.” To them, having a healthcare system that covers everyone seemed like a given. Overall, my internship made me realize how much the American people would benefit if the US healthcare system was restructured using the NHS as a model. Personally, as a future doctor I know that I want to work within a healthcare system that allows me to help all people in need of medical attention, regardless of how much money they can pay.