I went into the GP after calling ahead because I was struggling terribly with my sleep. I had just finished my master’s degree and was trying to decide whether to pursue a PhD on the same course with one of my advisers, whether to look elsewhere for a different program or change track altogether. Whether to look for work here in Scotland, or go back home to the US, either for further studies or to start a career.
It had been a week of only an hour or two of sleep per night, if that. Or maybe it just felt like that. Regardless, I was worried about insomnia, depression, severe anxiety, or some other factor, and I thought to myself: I’ve paid the NHS surcharge for my visa. The visit will be free, so I will just call and see if they have me. They asked me to come in, and I explained everything to a really kind GP.
They left me with a few questions and some instructions. Do you drink coffee? Yes. Do you drink alcohol? Yes, but not frequently. “Okay,” she told me, “stop doing both and see how you feel in a month.”
In America, I’m sure I would have left with a prescription, or at least been solicited for one. And I use the word solicited very intentionally. I’m not saying one way is better. I’m certainly not condoning the prescription culture in America, or the way it has been so heavily influenced by pharmaceutical companies and drug manufacturers.
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Fast forward four years. My wife and I returned — this time married. She was on a PhD program, I was looking for work and found a job. Eventually, we decided it was time to start our family. Our first son was born at the Royal Infirmary. He came early, and the care we received over our week-and-a-half stay was nothing short of exceptional — at times, truly heartwarming.
And yet throughout our stay, one thought kept creeping in: imagine what we would be paying back home for this. Or imagine if we didn’t have insurance — or not enough of it — and our son had needed this level of care but, because of the personal cost, didn’t get it.
The next couple of years, our son had some more run-ins with the NHS. We called 111 on multiple occasions. We took him into the GP for things we didn’t know about but were probably nothing, and a few times we received a level of care that, to be honest, felt over the top — but we were grateful for it.
Then, late one night, he had a low temperature and was ill. We phoned in, gave his symptoms as clearly and accurately as we could, and were told that an ambulance would be on its way shortly.
At first, I thought they had misunderstood me. I ran back through the symptoms again, thinking I had made something sound worse than it was — thinking I had read out his temperature in Fahrenheit rather than Celsius, or said something else that made the situation sound more urgent than it was. But it wasn’t just the urgency that was running through our heads. It was that nagging part of our brain thinking about personal cost. Although personal costs are often significantly mitigated by insurance coverage, the underlying average cost of an ambulance ride in the United States is about $1,500. That’s not a typo. I’ve checked this multiple times.
The ambulance came. Took our son and us to the hospital, where we sat overnight, to be told what we thought all along: he was a bit ill, keep an eye on him, see if the blood tests came back with anything funny, but otherwise — rest and relaxation. Our interaction ended there. Back in the United States, the interaction would have ended a couple of weeks later when a bill arrived in the mail, or, as happens with many families, a few years later in court, or when the debt collectors come to settle accounts. Because the bill in America always comes at the end. Here in Scotland, it comes at the beginning.
There are still times when family and friends back home don’t quite know what to say when we talk about the NHS, or going to the doctor, or going to the hospital. There’s a bit of hesitance, a bit of reluctance. Even the most open-minded — we can see them thinking: Really? Did you get what you needed? Is it safe? Did they just look you over and push you out? Did you have to wait a year and a half to even get in the door? Could you look for private coverage, just to be safe?
I can understand the reaction. And as I said, NHS Scotland is not above fair criticism. Right around the time my wife and I were having our second child, The Herald ran a special investigative series on the crisis facing Scottish maternity services. Among the highlights were reported workload pressures, workforce shortages, and cases of negligence — some of which related to the Edinburgh Royal Infirmary, the very place my wife and I had been only days earlier. The series was rigorously investigated and represented the truths faced by hundreds of families across the country, if not more.
I was glad that we had just had such a recent experience — although perhaps they came in the right order, with our baby being delivered before The Herald exposé. But the juxtaposition between the investigation and my wife’s deliveries reminded me that the daily interpersonal realities don’t always align with the big picture. Significant structural deficiencies, significant structural pressures, high-level debates about funding, philosophy, approach — at the end of the day, these are not always reflected in what is happening on the ground.
Our experience has shown us — in maternity wards, emergency waiting rooms, and GP surgeries — that the service is full of hardworking individuals, sometimes pushed to their limits, yet doing the most they can within those limits. Is one system better than the other? I’m not really in a position to say.
But what I can say is this: to the NHS maternity services — midwives, physicians and surgeons, nurses, consultants, janitors, and everyone else — thank you for my wife and my boys.