While planning my trip I had, I had a conversation with MM who works for NHS Western Isles in the IT department. MM told me her daughter lived in Portland Maine and we arranged to meet for a coffee.

Eleanor told me the thing she missed the most (apart from her mother of course!) was the health service. Eleanor and her husband have to pay a large monthly sum to allow them to access healthcare and this does not alway meet the costs required some prescriptions are not covered by the cost and appointments to specialist services such as dermatology, physiotherapy etc incur additional charges.

If a person was really ill and attended a hospital they have to be treated, they cannot be turned away if they don’t have health insurance; but bills will be issued following the treatment this has been known to result in bankruptcy and leave people destitute. I think people very easily forget the service provided by the NHS is the envy of many countries- something I have heard a few times over the last few weeks, like Eleanor you don’t appreciate what you’ve got until its gone.

Flu shots!

One aspect they take really seriously in the US is the administration of Flu vaccine, everyone is encouraged to get vaccinated but particularly healthcare staff. A very structured programme commences on the 1st October starting with frontline staff and progressing out to all other healthcare associated staff. It is now common practice that if staff decline the vaccine and they have any contact within 6 feet of patients they have to wear a face mask throughout the flu season!- this is compulsory and has made staff take the vaccine. Staff who refuse also have to sign a form which asks them to confirm that they are aware of facts such as

* I understand I cannot catch Influenza from the flu vaccine

* If I catch flu I may spread the virus for 24-48 hours before symptoms appear

* influenza is a serious condition that kills thousands of people in the US every year

Etc….and then the staff member has to sign and state the reason for declining and accepting that they have to wear a mask within 6 feet of a patient.

This is another example of difference between NHS and US. Employees of the NHS are encouraged to be vaccinated but there is no penalty if they decline.

Lyme disease

When considering Lyme disease in healthcare there is much debate about the scientific evidence regarding the treatment required. In USA the Infectious Disease Society of America (IDSA) is responsible for issuing evidence based guidance for the diagnosis and treatment of Lyme disease, they were last published in 2006 and are being reviewed and updated at the moment.

Three aspects are subjected to particular criticism the sensitivity of serological testing, the presence of symptoms after completion of the standard treatment and the continuing presence of non- specific symptoms following completion of treatment.

Serological testing is undertaken using a two tier testing protocol

1-Enzyme immunoassay test which is looking for the presence of class specific IgM and IgG antibodies to Borrelia Burgdorferi if no antibodies are detected the result is negative, if there are antibodies detected the test is equivocal or positive and is sent for further analysis using western blots

2-Western Blot test- this also tests for antibodies against Borrelia Burgdorferi, it looks for specific protein patterns, the interpretation of the bands requires the patient history of tick bite/symptom development to conclude the result

Standard treatment is prescribed for patients with Erythem migrans or positive serology, antibiotics for 14 /21 days and in the overwhelming majority of patients are successful, additional antimicrobial therapy has not been proven to be helpful, and in a world concerned by the over use of antibiotics and the increase of antibiotic resistant infections caution should be advised with prescribing extended courses.

Continuing symptoms as is the case with many infections, some or all of the patients symptoms may continue even after the infection has been microbiologically cured, bacterial debris may still be present in the body but this does not necessarily mean that the bacteria is still active. The symptoms attributed to Lyme disease often do not resolve immediately and you can readily understand why patients may feel that they have not had enough treatment. It is recognised that patient can suffer from prolonged neurological, cardiac or arthritic symptoms following a Lyme disease diagnosis.

There is also another aspect to this; where managing continuing prolonged symptoms when the patient has never tested positive for Lyme disease.

In the USA insurance companies meet the costs for treatment and will pay for the treatment in the recognised guidance only, this has led many people to seeking support from clinics that are set up to treat Lyme disease only and the patient has to meet the expense themselves, patients are paying $10,000+ for treatments of extended course of treatments (including antibiotics).

I met with a Lyme disease patient called Sandy and she spoke about the profound effect the disease had on her life and how it impacted on her physically, socially and emotionally. Sandy attended a clinic that specialised in Lyme disease and was prescribed a treatment regime that included a large amount of medication and lasted for three years. She had to meet the costs of this treatment herself. She has stopped the medication but continues to suffer symptoms of fatigue, joint pains and fibromyalgia.


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