A Tale of Two Countries

TO THE EDITOR:

Having completed my internal medicine residency training in Boston and the equivalent core medical training in the United Kingdom, I found DeWitt's viewpoint (1) particularly interesting. When I reflect on my personal experiences, the autonomy afforded to individual clinicians in the United States, in addition to the relative ease of access to advanced health care technologies, is a definite and possibly understated bonus of training and practicing here. However, the considerable administrative duties associated with practicing in this country are a notable challenge. Physicians in the United Kingdom are largely removed from the struggles of coding patients' various diagnoses and completing different forms when attempting to capture the required reimbursement for a particular clinical encounter. Less time spent on these administrative activities affords them more time for the most enjoyable and relevant part of medicine: talking to patients. Physicians in the United States—who often start the day earlier and finish later than their U.K. counterparts—have to provide sufficient details to communicate with their colleagues, ensure reimbursement from many different payers, and meet the personal standards to satisfy the palpable concern for possible future litigation when documenting a clinical encounter. The end result is reduced clinical efficiency (2) and satisfaction (3) and the continuing need for a solution to help address this painful burden and less-than-optimal situation for providers and their patients.