It has been nearly two years since I wrote a post about something I learned as an American expat in the United Kingdom of Great Britain and Northern Ireland. If you are new to this blog and don’t know what the heck the posts in this mini-series are about, then I recommend starting at the beginning of this ongoing mini-series here.
Pharmacists in the UK are mini doctors. They have a much broader range of responsibilities and powers than pharmacists in the USA. The idea behind their superpowers is to take the load off of the public health system, known as the NHS.
From a UK patient perspective, pharmacists are incredibly helpful, sometimes more-so than a general practitioner (GP). They are experts on travel destination vaccinations/medications, they can write and dispense prescriptions, and they can administer flu shots and many common vaccines (i.e. HPV, Hepatitis A/B, Yellow Fever, MMR, Chicken Pox, etc.). The best part is that they provide same-day service versus waiting for weeks for an appointment with a patient’s GP.
The medical system in the USA is incredibly expensive and is over-the-top in many scenarios. One example that comes to mind immediately is obtaining a birth control pill prescription so let’s compare this process in the two countries.
In the USA, obtaining a birth control prescription requires a one-hour appointment with a gynecologist who will do a full exam, including a PAP smear. I have always wondered what a PAP smear has to do with preventing pregnancy. The answer is nothing! This appointment and the accompanying tests are so that the practitioner can bill more services and pad their pockets whilst the patient pays more in copays and deductibles and unknowingly drives up their own healthcare premiums in the process. And it doesn’t end there…
Based on the patient’s health insurance plan (if they are lucky to have one!), birth control may or may not be free and the free birth control is typically a subset of all birth control brands, hormone levels, etc. which may or may not mesh well with the patient.
The prescription is valid for one year and then the patient has to repeat this process!
In the UK, all that is required to obtain a birth control prescription is for the patient to walk to her nearest pharmacy and ask the pharmacist for a prescription. It is a process that takes five minutes, the patient will be given a three-month supply, and birth control pills are free in the UK.
Another example – and the one that prompted this post – is with travel advice and vaccinations. I will be traveling to Peru in just over a week and I recently came across an article on how to deal with altitude sickness (Machu Picchu and Rainbow Mountain are located at high elevations). This article mentioned the prescription medication Acetazolamide and its off-label use to prevent altitude sickness.
Today I walked three minutes to the pharmacy at the end of our street and spoke to the pharmacist about my Peruvian itinerary. After an informal 10-minute interview where he provided me with his personal advice (he’s visited Machu Picchu and hiked some of the Inca Trail) and asked me a standard set of questions (taking any current medications, list of current diagnoses, and any known allergies), he offered to prescribe me the medication.
A few moments later, he handed me the tablets and I walked out of the pharmacy. It took 15 minutes of my time and cost £12 ($15 USD).
This same example in the USA would be incredibly complicated, time-consuming, and expensive. The patient would need to make an appointment with their doctor. The doctor’s visit would be billed at $200+ to the patient’s health insurance company. The patient would pay a copay, deductible, and/or coinsurance for the doctor’s visit (on top of their monthly insurance premiums!). The prescription would [usually] be sent to an off-site pharmacy. The patient would travel to the pharmacy to collect and pay for the prescription.
Neither country’s healthcare system is perfect but if we could mesh the two, the result would be something really great.