A Letter From The Spinal Cord Injury Unit

Dear Darren,

Your new puppy was with you in the car crash where you sustained your spinal cord injury. He was miraculously uninjured and is now staying with a friend while you’re here. You talk about him frequently—about how he’s named after a character from Star Wars, about how he’s going to grow so much bigger than the vet predicted, about how he looks like St. Bernard but he’s really a boxer mix.

On the first day you arrived, I went into your room to make you custom resting hand splints and explain why you need to wear them at night. I told you, “Since right now you don’t have any movement below your shoulders, these will help you position your hands to protect the length of the tissues. That way if you regain movement, you will still be able to have full motion in your hands.” You responded, “When.” And I said, “What?” You repeated yourself, “When. When I regain movement.” I looked at you—twenty-seven, messy dark hair, and five o’ clock shadow growing in. I didn’t know what to say.

Some patients regain a lot of movement. Some don’t. Some patients come in unable to do anything besides bend their elbows and leave able to lift each individual toe. Others leave the hospital without new movement. I couldn’t predict which category you would fall into. I wanted you to be hopeful, but I also didn’t want to promise you something I couldn’t guarantee, so I just smiled hesitantly at you and affirmed, “When.”

Then, you were unable to move your fingers or open or close your hands at all.  Now, your physical therapist and I are astonished every day about how you’ve been steadily regaining movement and function. I remember the day you told me, “I have a surprise for you,” and you showed me a thumbs up as I ooh-ed and ahh-ed. “I’m just waiting for the day when I can give my mom the middle finger,” you told me mischievously. It’s been a joy celebrating the little achievements with you.

We’ve worked on all sorts of aspects of life that were interrupted by your injury—accessing your phone, brushing your teeth, getting dressed, toileting, participating in hobbies, etc. We focused just on compensatory techniques at first, adapting your environment or the way you did things to suit your abilities at the time. Then, as you got more movement back, we added in practicing activities the way you used to do them and increasing your strength and endurance. I’ve seen you go from relying on someone else to feed you, to using a universal cuff, to using adaptive silverware, to feeding yourself with typical silverware. You’ve made so much progress.

Today, your friend brought your dog to visit and of course, we incorporated him into our treatment session. At that time, you were just starting to get some finger function, so we went outside and played fetch to practice coordinated arm movement and grasp and release patterns. I noticed that even though you were throwing the ball, he kept bringing the ball back to your friend because she’s been the one caring for him for the last six weeks. I’m sure you noticed too, and I’m sure it hurt—a tangible reminder that the world is moving on without you while your life is on pause here. I can only imagine how frustrating it must be to feel as though you’re sprinting and fighting just to return back to your starting point, where you used to be. I wonder if every victory comes with the glum realization that the things you’ve been working so hard to do again are the things that came easily and without thought.

I’m sorry that this happened to you. I can’t do anything to change your circumstance, and I can’t return to you what has been lost. I can only cheer you on, assure you that you have the whole medical team working together to provide you the best care, tell you I’m proud of how far you’ve come, and continue to work with you on things you want and need to do. I want so badly for you to be able to stand up and leave the hospital right now, but regardless of your level of function, know I will be fighting alongside you to maximize your independence and quality of life. We’ll take it one day at a time.  

Sincerely,

Your occupational therapist

*Disclaimer: Details of the story changed to protect privacy of the patient



Stacey Lau is an Occupational Therapist and just graduated from UTMB.

Stacey Lau is an Occupational Therapist and just graduated from UTMB.

 

The Ethics of Medical Mission

Over the years, as access has improved and awareness has increased, medical trips abroad have become increasingly popular. What was at one point a “once in a lifetime” opportunity is now much more available to healthcare students and professionals. It is not unusual to take a week to head off to far off places and provide some much needed medical services. These opportunities afford many lessons to be learned and memories to be cherished.

However, it must be reminded that the “rules” still apply when it comes to medical trips abroad. There remain professional boundaries that should not be crossed; just because one is outside the jurisdiction of their professional governing body does not mean that ethical practices do not apply. On the contrary, it would be even more important to continue providing ethical, competent healthcare to those populations that need it most.

The idea of a medical trip abroad is an alluring prospect to many in the healthcare field. The idea of a chance to see countries that are not often visited by tourists, and to make a meaningful difference in the lives of local residents is very appealing. We can see the shift in popularity through the awareness of programs such as Doctors Without Borders, in professional schools offering international rotations, and with the increasing emergence of “voluntourism” programs aimed at pre-professional students. Dr. Joan Paluzzi, a medical anthropologist and former trauma nurse with years of international experiences, highlights the excitement of participating in a healthcare trip abroad: “these are opportunities to witness the challenges of healthcare, and health, in places where profound poverty becomes a major risk factor.”

Maranda Herner, a first year resident in Internal Medicine at UC Denver, expresses a similar sentiment regarding her elective rotation in the country of Malawi, which consisted of a lot of malaria cases in the pediatric ward of the hospital: “I learned the way of life is very different than ours, both troublesome things like rape and droughts, as well as simple things like making a daily fire for cooking and spending more time visiting with people.” She also had to adjust her expectations in regards to the delivery of healthcare. Maranda notes that “unlike in the United States, where we value shared decision making between the physician and the patient, in Malawi, what the physician says is what happens.” In particular, she emphasizes that the attitude towards end of life care is in stark contrast to our own, and that healthcare providers are rarely accused of wrongdoing.

Despite the increase in awareness of these opportunities, there is an educational gap surrounding what should be expected on a healthcare trip abroad. As pre-professional students, as current professional students, or as current healthcare professionals, do we go on these medical trips abroad willing to provide any medical care we deem fit for a certain situation? Alex Anderson, a medical student at Western University of Health Sciences in Lebanon, OR, explains what he expected before his medical trip to help refugees currently residing in Thailand: “At the time, I knew that most patients were refugees, but I didn’t know much about the infrastructure, I just knew that the most common goal was to rectify nutritional deficiencies in our patients.” What often gets lost in the excitement of one of these trips is that although we are in an environment which differs from our normal healthcare duties, the responsibilities to one’s patient remains unchanged. This involves providing compassionate, competent, and most importantly, ethical healthcare.

A proper frame of mind can make for a successful international experience, whether it is for healthcare volunteering or for an elective rotation during a course of study. According to Dr. Paluzzi, “a student will get much more from the experience than they can possibly return to the patients and colleagues they will encounter along the way.” She also mentions that it is helpful to have a grasp of some global issues that may be encountered when abroad. These are often countries where high-tech medical devices and well-stocked pharmacies are not available, so the delivery of healthcare requires different skills and a level  of creativity that is not always expected with healthcare delivery in the United States. As alluded to above, we should remember that ethics are without borders. A medical trip abroad should not be treated as a chance to perform operations or try an unfamiliar treatment that was not provided in healthcare training. Rather, one should use the skills they have already acquired, learn from the people and patients around them, and continue applying sound, ethical practices to their healthcare delivery when abroad.

When we agree to participate in a healthcare experience abroad, many ideas can run through our minds. There is a lot of excitement, but it can also be nerve-wracking to step outside our comfort zone where the standard of healthcare is vastly different than our own. Alex Anderson admits, “At times I did feel a bit uncomfortable (on my trip to Thailand), but only in the sense that our work could at times feel just like a stopgap.” These trips often occur in regions of the world where healthcare services are desperately needed. Despite that need, it is imperative that we not take advantage over vulnerable populations. Dr. Paluzzi encourages students seeking out international experiences to “be humble, learn from the doctors who do the work day in and day out, frequently under impossible circumstances.” We should continue to remember that ethical healthcare practices follow us no matter where we end up serving as members of a healthcare team.  If we remember this, it enables us to have a successful, educating, and fulfilling international experience.


Paul Bluhm is an OMS-II at the Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Northwest

Paul Bluhm is an OMS-II at the Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Northwest

 

The Rise of Prescription Drug Prices

The price index for brand drugs has nearly tripled since 2008.  The average price of Humira and Xarelto in the U.S. is more than double the price than in the UK. Not only are U.S. drug prices more expensive than other countries, but they also continue to increase exponentially, despite political pressure from Capitol Hill. In mid-November of 2018, Pfizer announced they will raise the prices of 41 drugs. The pharmaceutical industry spends the most money on lobbying congress, nearly 40% more than insurance, the second biggest lobbyist group. Political influence is a major factor for the persistent drug price problem, as legislation becomes harder to pass and implement.  

Are generic drugs the solution? Generic prices have decreased since 2008, compared to the sharp increase in brand drugs. Generics combat the problem by providing a cheaper alternative. However, pharmaceutical giants limit the power of generics through patents. Let’s get back to Humira. Humira is protected by a portfolio of over 100 patents, which makes a generic version impossible.  Hassan Zreik, Co-Founder of Visrex states, “These layered patents limit competition in the industry, which leads to a monopoly on drugs that could save lives. This is the problem with the pharmaceutical industry. Manufacturers are too comfortable on top because they can limit competition with ease, which allows them to set any price they choose.” At the end of the day, this affects everyone in the United States, whether they have insurance or not.

The biggest sector affected by this ‘monopoly’ in the pharmaceutical industry, is the uninsured population. Uninsured patients must pay the whole cost of the medication if they elect to fill the prescription. Some patients may not fill the prescription because they cannot afford the outrageous cost of the medication, which could be a life-saving treatment.

The insured population is also affected by the high drug prices. Insurance premiums and co-pays increase as a result of the high prices. Ultimately, the insured patient is paying for the price increase on those medications. The co-pay reflects the general trend in prices, which is trending upwards. Ali Zreik, Co-Founder of Visrex states, “A patient could pay more for the co-pay than the actual cost of the generic medication, because the co-pay is set to reflect both brand and generic reimbursement.”  So why not pay cash for medications that are cheaper than the co-pay? Legislation. As stated above, the top 2 biggest lobbyist groups are pharmaceuticals and insurance. The white house has expressed concern regarding this issue and is pushing for legislation to increase transparency.

Innovation is necessary in order to address the growing drug price problem. Legislation to increase transparency and limit the use of patents is important in controlling the rise of drug prices. However we must utilize technology and innovation now, to make the industry more efficient, which will in turn target high drug prices. Visrex plans on releasing a direct-to-consumer feature, which will allow patients to purchase drugs at wholesale price directly from the platform. Hassan Zreik states, “Our goal is to allow everyone in the industry to access our platform, from the manufacturer down to the consumer. Direct-to-consumer will save patients a ton of money on their prescriptions, especially those who cannot afford the current upcharge and insane prices on medications.” The Zreik brothers are leading a change that is necessary for the pharmaceutical industry. The solution to this seemingly everlasting problem is complicated. Innovation, such as Visrex, directly address the problem and is a step in the right direction.  


Hassan Zreik is the Co-founder and CEO of Visrex. He is an MD/MBA candidate at Michigan State University College of Human Medicine and Eli Broad college of Business. He earned a Bachelor of Science from the University of Michigan. Hassan is a business executive with valuable experience in innovation and strategy with a focus in healthcare. His research is widely published in several prominent medical journals. Hassan is a community advocate and sits on the executive board of a few community non-profit organizations.

Hassan Zreik is the Co-founder and CEO of Visrex. He is an MD/MBA candidate at Michigan State University College of Human Medicine and Eli Broad college of Business. He earned a Bachelor of Science from the University of Michigan. Hassan is a business executive with valuable experience in innovation and strategy with a focus in healthcare. His research is widely published in several prominent medical journals. Hassan is a community advocate and sits on the executive board of a few community non-profit organizations.


Entrepreneur and pioneer in pharmaceutical innovation Ali Zreik is the Co-Founder and CEO of  Visrex , an innovative marketplace where pharmacies can shop, compare and save. Ali is a leading entrepreneur, strategist, and innovator with a proven track record of success in executive growth and business operations in the healthcare industry.   His healthcare experience and innovative thinking fueled the founding of  Visrex , which became a success story in the pharmaceutical industry. Ali is currently completing his Masters in Business Administration.

Entrepreneur and pioneer in pharmaceutical innovation Ali Zreik is the Co-Founder and CEO of Visrex, an innovative marketplace where pharmacies can shop, compare and save. Ali is a leading entrepreneur, strategist, and innovator with a proven track record of success in executive growth and business operations in the healthcare industry.


His healthcare experience and innovative thinking fueled the founding of Visrex, which became a success story in the pharmaceutical industry. Ali is currently completing his Masters in Business Administration.

 

Getting Social With The Social Workers

If you’ve ever tried to give up sugar or begin an exercise program, you know how hard behavior modification is. Personally, I barely made it through the 5 days of sugar withdrawal migraines. Yet somehow, as healthcare professionals, we seem to forget how difficult change is when prescribing treatment for our patients. “Improve your diet” “Exercise more” “Stop smoking” “Take this twice a day”. We rarely stop and think about the nitty gritty details of how to actually initiate and maintain meaningful behavior change. At best, our patients have the cognitive ability, motivation and adequate resources to change their daily habits to improve their health. At worst, there is cognitive deficit, lack of motivation, and socioeconomic complications. With limited time and scarce healthcare resources, how are we to help these patients? The short answer is, healthcare teams desperately need social workers to bridge the gap between what is said and done in the office to what is actually implemented at home.

I began my career in social work as a residential counselor working with adults living with major mental illness. In this role, I was a member of an interprofessional team made up of nurses, social workers, clinical counselors and psychiatrists. Our team was a well-oiled machine. We met regularly to comprehensively assess our patients’ needs and each person on the team had a unique role in assisting the patient to reach their goals. Psychiatrists prescribed medication with input from the rest of the team, counselors provided insight into psychological issues the patient was experiencing, nurses addressed medical issues, and social workers did basically everything else. I feel like we were the “catch all” members of the team. If a patient needed to apply for social security or food stamps, we helped them. If someone needed transport to an appointment, we provided it. If someone on my caseload needed help finding a job, I worked on their resume with them and brought them to apply and interview.

Patients’ goals could include anything from something as seemingly simple as learning how to grocery shop and cook to becoming independent in the area of medications. Some patients required more support than others. I could spend up to 5 hours a week working with one patient. Some individuals truly need that much help to become medically stable and independent.

This is just one story of how social workers are a vital part of a treatment team. Social work is a meaningful profession dedicated to action and the power to make a difference. The Steve Hicks School of Social Work at UT Austin puts it best - Social workers pull communities together, help individuals and families find solutions, advance changes in social policy, promote social justice, and foster human and global well-being.

As for me, I ultimately chose to pursue a career in pharmacy for a variety of different reasons. Among those, I wanted to focus on more clinical aspects of patient’s health while being able to make a decent living. I could have pursued more education for a higher salary, but the potential increase in pay would not have accounted for the large amount of loans needed for a higher degree.

The profession of social work as a whole is vastly overworked and underpaid. In other developed countries, roughly $2 is spent on social services per $1 spent on healthcare. In the United States, we spend 50 cents per dollar. I would like to say that salary wasn’t a big factor in my decision to change careers, but that wouldn’t be true. There were times I couldn’t survive financially. When I broke my arm in a snowboarding accident in 2010, I had to choose between paying my medical bills and buying food. At the end of the day, I had to get a second job. It is absolutely unacceptable that someone with a college education who is working full time cannot afford basic life expenses. This is the situation faced by many social workers in our country.

As a new generation of healthcare professionals, we have the power to impact change. We must recognize and appreciate the unique role of each member of the team and advocate for progressive, inclusive policies. We are no longer in the era of each man out for himself. We are in this together.


Sarah Piccuirro is a former social worker now pursuing her pharmD, As a result, she has some valuable insight into interprofessional collaboration that she loves to share with others.

Sarah Piccuirro is a former social worker now pursuing her pharmD, As a result, she has some valuable insight into interprofessional collaboration that she loves to share with others.

 

Around The World Of Nursing In 20 Minutes (Audio Interview)

James: Hey Everybody, welcome to the Healthcare Scholar. We are an online publication, not a podcast, but today we are going to do a mini-little podcast interviewing two amazingly unique students from different backgrounds. So we have Hannah Ho, from the US, the University of Texas at Austin. And Emily from the UK. They’re both nursing students, and I’ll let them talk a little bit about themselves. Hey, welcome everyone!


Hannah: Hi!


Emily: Hey!


James: So let’s hear a little bit about yourselves and your background. We can start with Hannah.


Hannah: Okay! I’m a fourth year nursing student at the University of Texas at Austin. In 2017 I finished a business foundation certificate, and now I’m working on a business in healthcare certificate. I’m really interested in the business of healthcare.


James: Okay, so the business side and also nursing. That’s quite the combo. What about you, Emily?


Emily: Hi, my name’s Emily Beuaie, I’m 23 years old and I’m studying adult nursing at the Sheffield Hallem University in England, which is in the North of England. I’m in my third year, which is the final year for us here in England. Yeah, that’s me really.


James: Cool, so just a brief background there. I also wonder what are the paths you took so far just to get to where you are now. We can flip around, so Emily what about you?


Emily: I didn’t always want to do nursing. In fact, I was quite opposed to nursing originally. Both my parents trained as nurses, so I wanted to do something a bit different. I didn’t want to go around and down the same path. So I went and did an English literature degree first, after I’d finished at school. So undergraduate degrees are usually three years here in England, so I did three years of English literature. Didn’t really enjoy it. Wasn’t really for me, unfortunately. Although I loved reading and loved writing, I didn’t really love the academic side of it so much. About halfway through I gave my parents the fright of their life and told them that I wanted to go do nursing! They were a bit worried that I was going to drop out of my English degree at the time. But no I finished that, I graduated, and I went straight into nursing after that. I graduated in July, and then I went straight into nursing in September of 2016. I did a bit of volunteering before that, to decide if that was actually what I wanted to do, and I realized it was. I wanted to do something more practical, I wanted to work with people, and I just think there are so many different areas you can go into in nursing. It’s a really good career, it’s so varied, so diverse, so I thought I’d have a go at it and here I am. A few years later with no regrets, I’m really enjoying it.


James: Wow, so it’s really just in your blood. You can’t get away.


Emily: No, no I can’t. We have a wide family of nurses, and my partner is a doctor as well.


James: You guys could open a whole practice together!


Emily: We actually could, it’s not a bad idea.


James: Hannah, what about you?


Hannah: So I came here straight out of high school thinking “Well I’m not sure what I want to do, so I’ll try out nursing”. And then I got into the UT program. About two years in, I started to become curious about business, and how in nursing I was just getting exposed to a lot of, you probably hear this a lot too, ‘the system is so messed up’. But then I got the sense that business people were running a lot of the things that go in healthcare, so then I thought “well, if I learn business, then maybe I could get my hands into that” and it didn’t feel like nursing could do that. So now I’m pursuing both!


James: Wow, yeah that hybrid I’m sure will serve you very well. I think that from the healthcare side, anyone who works in it should understand the big picture. That’ll be very unique and beneficial. Emily, the majority of the population that is reading and watching The Healthcare Scholar is from the United States.  I’m sure they have a very big question for you, let’s jump straight into it: for you, what are the most noticeable differences in your healthcare system in UK compared to what you’ve heard about in the US.


Emily: The biggest difference I think would be, for me, and a lot of the general public of the UK, not that I want to speak for everybody… but I think generally it’s probably the financial aspects of it. From what I understand, you pay insurance. So you have different insurance companies, and then Obamacare comes into that. I was saying to Hannah earlier, I’m a bit confused on how that works, exactly. But it is very different from how it works in the UK. Because in the UK we have the National Health Service (NHS) which is free at the point of use. Pretty much everything is free. We pay for prescriptions unless you are of low income. If you are unemployed you can get your prescriptions for free. But most of us pay for prescriptions. But actuall when you go for a scan, or when you come into the emergency department, you don’t pay anything. You don’t have any bills coming up after you in the post. It’s just completely free. Although I suppose some people would argue it’s not technically free, because we do pay national insurance tax. If you’re working and earning a certain amount of money, you pay a national insurance tax that goes towards things like the NHS. So it’s not technically free, I suppose, but I suppose it’s still less than you pay in the US. That’s probably the main point of difference that I’ve noticed.


James: Ok, so not even everyone has to pay the national tax if they do not make above a certain income?


Emily: I can’t remember the exact figures or percentages of what your pay or how often. But yeah, I know if you’re unemployed… like for me I have a part time job, but I don’t make that much money compared to people who work full time, so I don’t pay any national insurance at all. So I do get it for free, but my parent and my partner do pay national insurance tax. I think it’s pretty great.


James: That’s really cool! It’s a supportive system. Hannah what do you think about our healthcare system here in the US compared to these regards.


Hannah: Ours is pretty confusing, even to Americans. Honestly, it’s called a system, but in the US it’s not actually a system, because we have private insurance companies, private hospitals, we have the VA system, which is most like the UK model where it’s government run and works for people who are government employees. But other than that, it’s a lot of public, non-profit, private, insurance companies, hospitals, individual providers, all negotiating with each other on “ok you’ll pay me this much, but another person will have a different amount they get paid”, and then you have patients that may or may not be on insurance, might have government or private insurance, and everyone pays something different. A lot more complicated.


James: Yeah, definitely I would say so. Coming from the pharmacy side myself, just pharmacy insurance and prescriptions and that whole process, there are so many different parties involved. So healthcare as a whole is crazy.


Hannah: Something that I think is so cool about the UK is that the general practitioners make more than their specialists. So about 60% of UK practitioners are general practitioners, whereas in the US I think about 30% are in general medicine.


James: Wow, I didn’t know that. Emily is that your experience, that general practitioners make more?


Emily: I didn’t know that. I didn’t really have a placement in general practice or in community nursing at all, so that’s news to me as well I suppose.  


Hannah: For every patient they take, they get a certain amount of money, it’s called the cap-/???**** model. And then whether these patients come and see you or not, you get paid money. So they’re super incentivized to keep everyone healthy, and here are your flut shots, and all the preventative tests you need, and let’s not do anything extra.


James: In the US we’re also playing with the CAPTIN!?!?@?!@ model, things like ACOs, accountable care organizations, but it’s definitely not everywhere. Emily, Hannah is making you look bad, she knows stuff about the UK that you don’t!


Emily: I should’ve more research. I feel bad because I don’t know quite as much about the American system. I did try, I have tried over the years to actually try and understand it but it’s just so different from the UK. It’s hard to grasp when you’ve not grown up in that system.


James: Absolutely. Or even if you have grown up in the system it’s pretty difficult. So just based on a little bit of talk earlier, there’s something, an interesting point that was brought up: Emily, can you tell us a little bit about the waiting list in the UK?


Emily: Waiting list, yeah. I think most of us in the UK have been on a waiting list at some point. I’m assuming you mean waiting list for surgeries or appointments.


James: Yes


Emily: They can be very long, from personal experience. I’ve waited a few months sometimes for a scan or an outpatient appointment in a certain area. They are quite long, really. I suppose it’s for non-urgent procedures, presumably. If you’re critically ill, you will get seen and you will get treated. But yeah, they are long, they are long and quite frustrating actually.


James: Okay, so it’s kind of a triage of whoever really needs service right away is going to receive it first.


Emily: Yes, they do have certain targets to meet in certain areas. Things like oncology areas. Don’t quote me on this, but some areas I think you have to have an appointment within two weeks of seeing your doctor. They do have some limits and targets to meet.


James: That makes sense, because oncology you know, you can have a much worse symptoms or likelihood of mortality if you wait just two weeks.


Emily: Exactly


James: Ok, that’s very interesting. Since our publication is all about collaboration and professionalism, Hannah, how do you feel about the state of interprofessional collaboration here in the US? In terms of what they teach you in school and also what seems to be going on in actual clinical settings.


Hannah: I think UT may or may not be unique in this, but right now I’m in an interprofessional collaborative practicum class, where they bring together social work, nursing, medical students, and pharmacy students, to learn how to work with each other. What we do, what each role does. I think it’s only in its second or third year, so in that sense, interprofessional education seems kind of new. But I heard from staff at the hospital, because I work as a nursing assistant at the hospital, that students coming out of that program, they see the difference. So that’s a good sign. For example, some of our instructors that are older, they said “we wish we had your education, because we weren’t taught to work with each other and, as physicians, we are pressured to know all the answers, but apparently medical students aren’t being taught that these days, which is great”.


James: Yeah, that’s sort of the power of collaboration. Everyone is an expert of their own area. I guess we’re seeing a trend towards moving away from the physician-centric model and to a group-practice model. But it sounds like we’re not quite there yet, from what you’ve experienced. Emily, what about you? How does it feel in the UK for how much different professions work together in terms of who’s leading care and then also how well there is communication?


Emily: In practice, from what I’ve seen on my placements, I think the professions I see do work really well together and do communicate together. There is much less of a top-down model, a lot less doctor-centric, I suppose. A lot less of “all the doctors are God, he must be right” which is the way it used to be. Back in the day, when my parents trained, there was a huge hierarchy, and student nurses were right at the bottom. Doctors were ‘the Gods’. Now it’s a lot less like that, I think. There are a lot more health professions now, there are physios, occupational therapists, and social workers, and there are volunteers as well. I think it’s really great that we have all these professions now. In our course, a bit like Hannah I suppose, we have an interprofessional education module at university. I don’t know if that’s just at Sheffield or if they do it elsewhere. But every year of our course, we come together with the other healthcare students at university. So the physios, OT, social workers, paramedics, and we all get together and maybe do a project or some group work. And then we write an assignment on interprofessional collaboration, what we’ve seen in practice. And I think that’s really good, it’s really interesting to see other students. But we don’t, one thing that is missing, is contact with the medical students. Where I am at university in Sheffield-Hallem, there are no medical students at this university, that’s at the other university in the city, the University of Sheffield. So we really only have two days over all three years where we meet them. One in first year, where we do basic life support with them at a session, and then this year we have ‘smart day’, which is about a bit more advanced life support skills. So it seems strange to me because nurses and doctors come into contact so much in practice, so I think that’s something that could be improved perhaps in the UK. But overall, it’s moving towards a more interprofessional approach. I understand with the new nursing courses rolling out, more nursing students will be in lectures with other healthcare students.


James: Oh wow!


Emily: So it won’t just be one week where you spend time with them, you’ll have actually more lectures together with them. So I’m intrigued to see how that works, to get some feedback on that.


James: Yeah, I’ve never even thought about classes here in the US where different professions would share the same class together. I think that’s basically unheard of.


Emily: Yeah, it’s quite revolutionary.


James: Yeah, you guys seem to be ahead of us in that sense. That really brings a lot of new ideas to the table. We have time for two more questions. Emily, this is interesting because we had another nurse write an article for us on the topic of gender disparities in nursing in the US. In general, in the US, men tend to be paid a little more than women, which is often not fair. At the same time, nursing is unique because it’s almost 90% women in this field, compared to men. At least here in the US. I have no idea about the UK, what are your thoughts on gender disparities in the UK for nursing?


Emily: I don’t know what the exact figures are, but it’s predominantly female. I think in my group there’s maybe one guy. It’s mostly female still. In terms of pay, or wages, I think male and female nurses are paid the same, because it’s a public sector job, so the pay is set out by the government. Everyone is paid the same. So I guess it’s fairly equal, fairly fair. I did read that article actually, from the male student talking about a patient not wanting him to care for her because he was a male student. I’ve heard that actually before from other male students on placements. Feeling anxious about that, about looking after female patients, and you know, will they feel comfortable with me looking after them. It’s something that you don’t think about necessarily, as a female nursing student. It’s not something I really think about, because it’s a more typically female dominated profession. But no I really hope that more men will apply, because I think men have many wonderful things to offer nursing as well as women. My dad is a nurse, he does a wonderful job! I wonder what Hannah thinks of that.  


Hannah: Well, in my experience, on the floor at least, I heard that male nurses are really popular, because you do a lot of heavy lifting in nursing. If you’re smaller, or can’t lift something super heavy, you want someone stronger than you to help you out. If you’re a male nurse around who looks strong, everybody on the floor is going to call you.


Emily: That’s very true, my experience as well.


[laughing]


James: That’s a good, unique insight.


Hannah: In my class of about 60-something nursing students, we have four male students, and everyone knows their names.


James: Very interesting, so men are like celebrities in nursing, since there are so few of them.


Hannah: I also brought that up because the article talks about how it’s not always like that.


James: Final question, one thing that’s interesting here at least in the areas that I’ve practiced, is that there are a lot of homeless or underserved patients that come in without insurance or without a place to stay or without any funding. How is that taken care of in your health system, Emily?


Emily: If you’re homeless, you are treated the same as everybody else, I suppose. You receive the same free healthcare as everybody else. There’s no real difference there. In terms of social services, outside of the hospital, I’m not really sure what they’re like. I know that there are funding cuts in the UK, a lot of resources and staff in areas have been taken away, in certain social sect.s. So I’m not sure what services are available for people who are homeless, but I know that in hospital and in terms of what they pay, well they won’t be paying anything. That’s the short answer.


James: What about, you said people have to pay for their own prescriptions. When it comes to long term management, what do they do?


Emily: If you’re on long term prescriptions, I believe you can get discounts. If you are unemployed or if you are homeless, you would get them for free I imagine. You do have to fill in a lot of paperwork for that though, so that could be a barrier there. Also if you don’t have a permanent address, that could be quite difficult.


James: Hannah, what are your experiences in this regard?


Hannah: Well, for the homeless population in Austin, they don’t get healthcare until they have a life-threatening illness or if you’re a danger to yourself or if you’re drunk or high or if you’re having a heart attack. The emergency rooms are required, by law, to at least stabilize patients that come into the ER. So that’s how they usually get healthcare, and then maybe social work can discharge them to the mental hospital or back to the bridge where they came from. It’s pretty sad. For underserved patients, people with pre-existing chronic conditions that don’t have insurance, or people under the poverty line, hopefully most of them are on Medicare or Medicaid. If not, that’s tough luck.


James: On that dreary note, Hannah and Emily, I want to thank you guys very much for joining us today. It’s been very informative, a lot of unique insights into healthcare systems and also nursing in general. So thank you very much for joining us!


Hannah: Thank you.


Emily: Thank you for inviting me.


James: Alright, I’ll let you go, and hopefully a few years down the road we can bring you back on for a follow up interview!


Emily: Definitely, I’d be up for that.


Hannah: That sounds fun.


James: Alright, bye guys!



Hannah Ho studies nursing and business at The University of Texas at Austin. She is looking to improve individual and population health by broadening the reach of primary care services. In her spare time, she enjoys reading autobiographies or business books and training in wushu.

Hannah Ho studies nursing and business at The University of Texas at Austin. She is looking to improve individual and population health by broadening the reach of primary care services. In her spare time, she enjoys reading autobiographies or business books and training in wushu.


Emily Buet is a 3rd year student nurse (adult branch) studying in Sheffield, England.

Emily Buet is a 3rd year student nurse (adult branch) studying in Sheffield, England.