The Checkup with Doctor Mike - US vs UK Healthcare System with Dr. Ed Hope

Episode Date: May 14, 2023

Watch the full video interview with Dr. Ed Hope here: https://go.doctormikemedia.com/youtube/EdHope Ed Hope is an emergency room physician in the UK and a popular YouTube creator who specializes in reaction videos to medical drama and medical memes. Funny enough... so do I. That was the source of some YouTube "beef" that emerged between us a few years ago. Ed made his way to NYC to come on The Checkup so we could hash things out between us and finally lay the issue to rest. We also debated the differences between the US and the UK healthcare system, and which specialty is better: EM or FM. Follow Ed Hope on YouTube here: https://www.youtube.com/@DrHopeSickNotes Executive Producer and Host: Dr. Mike Varshavski Produced by Dan Owens and Sam Bowers Art by Caroline Weigum CONTACT: [e-mail]

Obviously, it blew up. We got your attention, and then, you know, I think it didn't help us out. I think it just fed everyone who likes the drama. That's Dr. Ed Hope, who works as an emergency room doc in the UK, but you may know him from his popular YouTube channel, Dr. Hope's sick notes. He makes reaction videos to medical dramas like Grey's Anatomy or medical scenes for Marvel movies or medical memes. And if you think that sounds an awful lot like some of my videos, you'd be right.

And that's kind of the point. You see, despite the fact that Dr. Hope and I are intellectual and educated doctors in our 30s, we're still YouTubers, which means we've got beef. I started getting, like, comments on my channel, like, you just want to be Dr. Mike. You're ripping off Dr. Mike. And I was like, no, and I kind of got a bit like, you're probably like more annoyed than I should. But who really stole the concept from who? Can somebody even own a concept on YouTube? A lot of questions needed to be answered. And we're mature adults, so I wanted to clear the air the best

way I know how. No, not a boxing match, but a good old-fashioned face-to-face debate. We sat down and got to tell our sides of the story from where the drama started to how it nearly sabotaged my business. It's how we found ourselves, two doctors from opposite ends of the earth, confronting each other right here in New York City. Take me through your head, mid-2017, this happened? Okay.

Or 2018? 2018. What was going through your mind when you saw my videos? And just to set up this situation for people, it's about reacting to medical drama shows. I put out my first one in mid-2018 of reacting to Grey's Anatomy. But Dr. Hope did his before. So you've done a few episodes. Now you see I did mine.

Yeah. What's happening in your mind? Yeah. So basically, I started a YouTube channel, I guess a year or two after you. And my channel was pretty rubbish. So I was doing what I thought you were. Like, if you said to someone back then, you're going to make medical videos on YouTube, what they look like.

That is literally it. I was talking about, like, this is a gallbladder. This is a heart attack. And the videos have got quite a lot of views now. But at the time, I looked like a rabbit in the headlines. Like, it was almost like infomercial style. Hi. I was like, what's that Simpson's guy?

It was like that. And I thought, and they're not working. No one was watching the videos. So I was like, well, how can I do something that's a bit more, a bit more fun? Yeah, and I thought, what did I watch when I was before medicine? So I came into medicine late, and I used to love House. And my friends even at the time when I applied to med school were like, you only want to go to med school because you love House. And obviously that hurt me because it was very true, you know, so you have to, I have to call it what it was.

And so yeah, I thought, you know what, I love House. So let's break down, like this journey in it. So that's what I did. And at the time, there were some React channels out there, but they, Dr. React stuff, but they were like the clip shows. Yeah. And I thought we could make a more narrow. Like Wired magazine or something.

Yeah, right. And Dr. Ken had one. I don't know who that is. Okay, cool. But there are a couple of other videos out there. So I... Do you know who Dr. Ken is? Oh, you can John?

Yeah. Oh, okay. Okay. Sorry. I didn't know that's the Dr. Kidd or something. Cool. And so I decided to, yeah, I thought I'd make like a long form. You know, what we all know,

as the kind of professional reacts, doctor reacts thing. Yeah, so put them out and then they sort of went like crazy big. Like for me at the time, it was like 10,000 views, 20,000 views. And I was like, loving it. And I was like, this is amazing. This is so easy. And then obviously, sort of, I think at the time my channel was getting more views than yours. So I was like, look at this.

This is how you do it, man. And then, because I was a fan, you know. I watched the videos before, really enjoyed them. And so I was like, yeah, this, this guy's got it going on, knows how to do stuff. And then, yeah, I saw you were doing that stuff. And I was like, oh, okay, cool. And then I thought maybe there'd be like a little link, little shout out or something. You mean when you saw those videos?

Yeah, when your videos came out, I was like, oh, that's kind of similar to what I'm doing. Then there was like a few more came out. But your videos, when my got 10,000 were getting 100,000, then a million's, then whatever. And then, yeah, then I sort of thought, okay, cool. So, you know, gave a little, sent you an email, said, yeah, we'd do a similar thing. Do you want to do like a collaboration or whatever? So I think I sent a couple of emails and then on like an Instagram message. And then around about that time when your videos are getting crazy, I started getting like comments on my channel like, you just want to be Dr. Mike.

You're ripping off Dr. Mike. And I was like, no. And I kind of got a bit like, you're probably like more annoyed than I should do. That's normal though. Right. I was like, you know, someone's doing similar stuff. And I was like, oh, I felt like I maybe it would be nice to have like a little link to it or maybe just like, hey, this guy's cool. And I felt like I was justified in that purely because I think people come up for like, you know, legal eagle and he would be, I think his first videos gave you like, oh, check out Dr. Mike. I've done this. I'm doing this professional reacts because he did it. And I thought even if, and I believe this to be true, we came up with the idea at the same time. time, you know, I don't believe you sort of looked and were like. But I thought even if I felt like it was still nice to have a bit of a like a shout out. And also, weirdly, I know that to be true because several times I thought, oh, this is a good idea for a video. I'll type it in and you've done

it. Some people have done it. So, you know, that has been proved to exist. So yeah. And then I think what I regret doing is, yeah, and I'm sorry about this actually. I think I did like a video that to try and end it this was but it just started it was and looking back it's so immature and to like i kind of did a video because i wanted to do all these people that were writing comments on my channel i wanted to just post something and i got bored of like writing a post so it's like i'm a youtube i'm just gonna write a video about it do a video about it and then i can just leave that link in and talk about the whole thing talk about what i thought happened and you know what it was just not a good idea to do okay because it's it's I think it's very confrontational so I think whenever you want to change

someone's mind you've got to like walk alongside them not not bad heads with them and I thought it was looking back very cringe but but yeah so that that was one thing I you know I didn't think I handled it in the right way and then obviously it blew up we got your attention and then you know I think it didn't help us out I think it just fed everyone who likes the drama and also it didn't make me feel good either. Like, you know, I talked about before the, you know, the sponsorship stuff when it goes wrong. It just put so much pressure on. That week at work was horrible, you know, and we've all had controversies in our lives, like, but we're not used to having that play out in the worlds. Yeah. I mean, we're used to be having just beasts made with our friends and

things, you know, a few people, not being having us on stage with, you know, hundreds, thousands, millions of people, that does not make people feel good. Yeah. So anyway, I think we kind of just left things where and then obviously we've connected over it. You sent me some really nice messages in the pandemic. So classy guy like that. Thank you. And yeah, I think we just, yeah, that's how that's how played out. Well, it's interesting hearing it from your point of view because from my point of view, you probably have no idea how, like I'm curious, how do you think Atlanta for me, or like, where do you think my head was at? Because I think it's going to be in a very different place than you think it was.

Okay. For me, when we were doing the channel, for the first year when we were doing the channel, we got fired by our MCN because they viewed us not successful of making content. They were giving us a monthly budget, and they said, we're done paying you because you're not successful. We don't think your channel is going to go anywhere. And we were actually filming in the YouTube spaces at the time where they allowed us to film for free if you had over 100,000 subscribers. And we had a med student with us.

His name is Donald Pettit. He's an ER doctor, actually, now. And he's a really good doctor. Shout out Donald Pettit. And he goes, you should react to watch one of these shows. And I'm like, dude, I hate those shows. They make me so angry. He goes, exactly.

That's why you got to do it. So at the end of that video, we said, okay, if you get this video, text number likes, I'll do it. Even though I refused, Dan was bugging me about doing it for a long time even before that because he said there's comments about it. But I'm like, dude, that's so boring. Who's going to want to see? And I actually downplayed the concept. So finally, we did it.

And even when I did it, I'm like, Dan, is this going to be even good? I don't think this is ideal. He's like, no, I'll edit it. It'll be good. We put it out. It blows up. It doesn't go trending, but it starts gaining views exponentially that I've never seen before. Then we put out right away.

He's like, oh, we got to follow this up with a good doctor. So we do Good Doctor. Now, Good Doctor trends like number one on YouTube. And when that happens, you start getting the sponsorship attention, media attention, like no other. And again, I'm a regular doctor. I don't know what to expect or how to deal with this massive influx of emails. And I'm getting people reaching out from real life of people who've known me wishing me congrats, people who hate me, people like you were getting haters about the Virgin thing,

people who wanted sponsorships, people who said I owe them something for using the show and that I'm stealing from the show. So there was so many, such an influx of emails that I was like, I just got to push through and keep doing it. And I don't know who's being genuine in this group and who's not. So I'm going to ignore it. And I remember, like, even we gained so many subscribers in that week, I tweeted something and you made like a joke that, oh, you know.

I wish you did it first, though, or something. And I'm like, God, why is this doctor attacking me when we're both doing the same thing? So I felt attacked when I shouldn't have felt attacked. It was a genuine thought you were having. And Dan and I were in Florida, in Kasimi, Florida doing a sponsorship deal when you published your video. And I literally lost, like, my emotional handle in the meeting of this brand deal that I'm with and Dan's like Mike you got to focus on like you're having lunch with the executives you need

to focus I'm like no and I'm showing the executives the comments because the amount of negativity that came in after that video was so big and I was like how do I fix this what do I do I'm so mad I don't feel like I cheated I'm so sorry man no no no I just this is a thing you never know where people are when you know when you have these things you're doing it from your point of you, you're like, look, I did this and look at this success. And at the same time, I'm like, I understand what he's saying. I wish you went about it differently. And I didn't know that I felt like, because you made the video, had I reached out and messaged you privately and been like, look, totally sorry, but this was not this thing. I thought you might even make a video

about me DME. Yeah, right. Because I don't know you as a person. I don't know what your motives are. But at the same time, I'm like, I want to make it right. Like, had we known each other or had some kind of communication. I was like, I would bring him on the channel. I would support, because I always want doctors to come on. Yeah, yeah. Like, that's always been my mission. And because this success was never planned, I thought I was going to do the same thing as you, like the gallbladder thing. You're right. The gallbladder thing. I love that. Um, so it was sad that it devolved to that. And now, even when, like, I'll make appearances on other people's channels, they'll reference this beef. And they'll, yeah, like, this is still an ongoing thing. That's why I'm

excited we get to talk about. Yeah. Yeah. Yeah. Cool. So that. That was where my head was. Yeah, I think, yeah, I think you're right in terms of the way I handled it. Because I stupidly thought doing a video would end it. Like, it was almost like, Dr. Mike doesn't want to chat about it. So this is, this is a line in the sand. Let's get on with it. Yeah.

But that's not the way the internet works. No, the internet's sense. I just fed the trolls and it. Well, you know, it was just, it was just un-negative energy, was it, putting that out. And people love negative energy. While our YouTube beef appears to be squashed, there's still plenty of professional beef between us. I'm a board certified doctor practicing in the U.S. Ed is a board certified physician practicing under the NHS of the United Kingdom.

These are two vastly different health care systems. And rather than debate which country's health care system was better, I asked the opposite. Which one was worse? What I'll point out about our system is that I think it's slightly misrepresented as being a purely, capitalistic commercial health care system, and it's not. It's actually a hybrid system in that there's a handful of people who are, or a percentage of people who are insured by their employer. They have employer-based health insurance. Like, for example, all my employees and myself are covered by my company pays their health insurance. Then there's a group of people

who are, like I say, over the age of 65, have a disability. They're covered by government, covered insurance that's paid for by the government by the taxpayers if you fall into a bracket of poverty you're also covered and you get coverage from the government and then there's people who pay out of pocket on their own who just like have their own business or something and they pay out a pocket and then there's people who are uninsured so it's a very messy system and because it's so hybridized there's a lot of ways that people fall through the cracks and horror stories are result so you have people who are like I just got fired from this job I'm about to take this job so I'm not covered.

I got in a car accident. And now I have these bills and I'm being bankrupt. So that's why our system sucks. And so in that scenario, does the previous employer not pick it up? There's a lot of weird rules. And each one will be like,

I'm covering you only until this period. This kicks in after you work for this period. It's very messy. And it makes it even messier for us doctors because when I treat a patient, I have no idea what insurance they have, what coverage they have, what recommendation I'm giving them how much it costs.

So it's impossible for me to be aware of what their financial journey with the system's going to be. Except if they're fully uncovered, then I know it sucks and I know what little things I can help them out with. Coupons.

So you actually have, that actually forms part of your management plan. Correct. Mate, that is insane. So I'll have a patient come in. This just happened the other day. I prescribed them in antibiotic clindomycin and or doxycycline.

I forgot which one I was. And I send it out. I have to be aware if their insurance covers it. If they're uninsured, I have to find them a coupon online to make sure they can pay for it and ask them ahead of time, can you afford this medicine? If not, I have to find a different one that is the same antimicrobial thing.

And then the pharmacy will call me and say, hey, the medicine's rejected by the pharmacy. And I'm like, why? They're like, you have to do a prior authorization. I have to call and argue. Why? This is a cheap medicine. It's doxycycline. It's available.

They're like, oh, it's because you ordered capsules. They only cover tablets. I'm like, you can't switch it. They're like, no, we as a pharmacist can't switch it. I don't even know the difference between tablets and tablets do you I don't know I don't know either and I'm like yeah give tablets one's cheaper yeah yeah oh my word is it but I just kind of that all that extra paperwork yes and that time and that money in that whole process it stops us from being doctors right that's crazy and how many in a sort of how long do you get for a consultation as a family

If they're a new patient and they're coming in for a quote unquote establishing physical visit, it's 30 minutes. Okay. What about if they're coming back? Fifteen minutes. Yeah, right. Okay. So it's basically the same in the UK. I think they have 10 minutes, but the BMA want to have 15 minutes. Okay. So that the-10 minutes is impossible. Right. I mean, some can take elderly people five minutes take off a jacket. Exactly. And that's, you know, or get on the couch. How do you talk about someone's mental health in 10 minutes? Yeah, yeah, yeah. But I think things just run late and people just, just, GP's end-offs thing. It's horrendous to be. Okay, so I've kind of summarised the US system. Summarise the NHS service. Yeah, so we have the National Health Service.

We're very proud of the National Health Service. It's publicly funded. People always say it's free. Yeah. The money just comes from somewhere else. So it gets paid free taxes. And yeah, it's done, everything is done on priority, essentially. But there is a private healthcare system too.

So people that can afford it and companies. Oh, so there is a private health. Yeah. So people, they're private hospitals and typically specialists will work a day, a couple days a week. And some people will be full time in the private practice, you know, orthopedic surgeons. The fancy ones. Right. And yeah, so people typically use that when they've got a lot of money or they just are fed out of waiting because the waiting list can be weeks to months for many different procedures. So give me an example. If I, Let's say I'm in the NHS. I'm a taxpayer. I have headaches that wake me up from sleep, that get worse with sexual activity. There are new headaches.

They're 10 out of 10, whatever. I'm trying to give red flags for headaches. And I come in, my GP and you need to see a neurologist. Yeah. Does that take a long time? Yeah. So we have things called two-week weights. Okay.

So these are whenever certain red flags, you know, pop up. then we can get... So an urgent visit is two weeks? Yeah. Wow. Yeah. If a patient has to wait two weeks in my office now, they're yelling at me. Yeah.

Yeah. And that's not an urgent. That's... But often the GP will send them to A&E, you know, if they feel like this, you know, a bleed or obviously, you know, they'll come straight to A&E and we'll see them in the emergency department. But yeah, the typical weight for cancer, you know, if people have got bowel symptoms that are, I think it's cancer, it's a two-week weight. Okay.

Is that longer there? So like, for example, I'm trying to think of a patient that I had that I needed to get seen early. Like, for example, if I have a patient with some kind of really bad esophagitis or gastritis from like a potential ulcer, I want them to get scoped early. They're not actively bleeding. So if I send them to the ERA need, no one's going to accept them. They're going to say, you need to go follow up. but they're actively experiencing serious symptoms and serious discomfort. I'll get them an appointment in two days.

Wow. Yeah. So I think the GPs here would probably more and more ask if they have private health care and they could make that referral. Got it. But if there's no kind of red flags, then it will, you know, they'll just make a referral to the system. And how long does that take?

Well, it depends. I wouldn't know, actually. Well, it'd give me like an average. But it would be weeks to months. Like people can wait a year for a hip operation. A year? Yeah. If they've got arthritis of the hit.

Yeah. This is how long, yeah. And the thing is within that, there's problems, right? Because they keep coming in. You know, hip operates a bad example for this. But say they've got sort of back pain. They're waiting to see a surgeon. They'll keep coming to A&E within that time.

Of course. Because their appointment's six months. And they'll, you know, the problem's still there. So they keep coming to A&E. So it's almost a false economy, right? Creates more work in the, in the sharp end and when it should be dealt with. That's so problematic in so many ways. But also, the NHS at the moment, I don't know if you hear, is getting hammered. Why is that? Everyone is striking. Doctors are on strike. I'm on strike at the moment. Really? This is not why I'm here. Wait. You're on strike at the moment? Yeah, doctors are on strike at the moment.

So do they have like people that fill in for doctors while you're on strike? Yeah. Really? Who are those people? Nurses are on strike and paramedics are on strike. But yeah, we have, yeah, so the juniors are on strike. The consultants, so the attendings are currently covering. The strike's ended last week, so we just do a few days at a time. You don't want to make the strike too uncomfortable for the system. Well, this is the thing.

And what is the strike? What are you requesting? Yeah. Well, also, I don't want to say too much as well, because the unions, are very much like doctors should not be on media talking about the strikes because it undermines the messaging, because we won't get the messaging accurate, we're not trained by the union, we need to do this properly. Okay, so since 2008, the junior doctor pay has gone down by 26%. So...

Gone down? Yeah. So in relative terms. I'm sorry, what's a junior doctor? So a junior doctor is anyone before in attending. So like a resident in our one? A resident would be one of the junior doctors, yeah. But you're not a junior doctor?

Yeah. Yeah. Wait, you're a resident? Well, we don't really have those terms. That's difficult. But I'm saying, take me through the medical education in the U.S. Sure. Sure.

So I'm going to have to, yeah, we haven't a system that was used like 20 years ago, and everyone uses the terminology from that, but we have a new system with new terminology that people rarely use. But let me just summarize it. So straight out med school. Well, do college. Start with college. Yeah, okay.

So you can go to med school at 18. Wow. Yeah. And it's five years. So you can be a doctor at 23 in the UK. Okay. So you're a doctor at 23. Imagine that.

I did an accelerated program so I was a doctor at 24. So I'm not that different. Oh, okay, cool. So we, yeah, so from there, you then do two years, what we call foundation training. And that is where you get put on six different specialties. So you're sent around. You have to do, you have to do medicine, hospital medicine, have to do hospital surgery. You have to do a community.

Are you practicing? Yeah. So you're practicing under the supervision. Yes, exactly. For those two years, okay. So seven now? Yeah. So, and you'll do community, so typically family medicine.

Okay. And then, and you'll do a range of specialties as well. So you might do obs and guine. That's what I did. I did palliative medicine as well. And it's, I had a fantastic time of my foundation. great hospital, like really supportive and, you know, you learn lots of stuff and you learn what you want to do as well. Of course. And in the, and actually in the second year of

foundation, that's when you're fully registered. So in the first year of foundation training, you're kind of like partially registered. You can still prescribe, see patients, but you, you know, your consultant has a bit more involvement. But then after that, you're essentially working independently as an F2 Foundation 2. You then go into core training. And that's when you apply to be what area you want to go into. Yeah. So let's just say in general it's medicine or surgery or family medicine. But there are lots of different ones. You can go straight into neurology. You can go straight into radiology. There's past ways in. But generally people do the core training. Then after that, you'll go into specialty training. So the core training, I know I'm just blowing your

mind here. The core training would just be general surgery. How long is that? Two years. But then you might say, I want to do lower GI, I want to do orthopedic, and then you're going to specialty training after that, and they're all different. Could be a few years, could be. Got it. So to be an emergency doctor, you do two years foundation.

You then do two years core training, and then you go into your specialty training. And how long does that take? It takes five years specialty training. hold on a second so you're doing five years med school yeah two years foundation yeah two years core yeah and then another five years er training yeah yeah you're training for like 15 years yeah that's longer than ours it's a long time significantly longer do you know how it is here so college you you apply straight after don't you straight after med school yeah yeah so you do college four years, med school four years, your residency, let's say you want to become ER,

I think ER is a four-year residency, and after that's it? Yeah. You could sub-specialize and do a fellow, but that's it. So 23, you finish school, two years foundation, you're 25, two years core, you're 27, and then five years. Yeah, I think it's maybe three or four. 32, 33, you could start as an ER physician. Yeah, well, as a, yeah, this is the thing. But with all that time, you're doing the job.

Of course, of course. So you're in your five years. So, oh, this is going to confuse even more. Oh, no. So I basically do a slightly different route. Because I wanted to do a bit of teaching, I wanted to do, like, the YouTube and things. So I finished after, I did my foundation training, and then I did a teaching fellow for three years, that you step out of the whole system. So I was teaching med students and doing my clinical work in ED.

And then I, from then, I just do locum work. So you essentially work as, you know, pick up shifts when you like. And so I'm basically working at the level of a core trainee, a junior, but I'm not. And you get paid less for doing that? Yeah. Yeah. Okay. So for me to get to the next, so given how much time I've been a doctor, I should be kicking on more than I am.

But because I've decided to do other stuff, I'm kind of... Such an interesting route. It's very weird, isn't it? But people are very, doctors aren't enjoying training at the moment. Well, I wouldn't either if it's so complicated. Yeah. But they don't think... They are service provision, as in they're there just to see patients.

Which, okay, people watch them and be like, yeah, right, that's the job. But you're supposed to have an afternoon training a week. You're supposed to be sent on courses. You're supposed to have consultants witness you do things. Of course. To progress you. Instead, you're just working. It is so bad in the hospitals at the moment.

In A&E at the moment, I don't know if it's the same in the US. We are capacity and then some. If you were in my hospital in the last few months, every single bay has two patients soon. And then there's hallway patients and this. All along the hallways. to bring a patient in from the ambulance. So the ambulance weights are crazy high. I think all the main, like the top priorities are getting seen just about.

But then what happens is that all the other ones suffer increasingly more, they're less priority. When you bring a patient in, it's down a corridor lined with trolleys that only fit two trolleys through. So everyone has to move out of the way when the trolleys come down. And you have to see a patient, assess them on a trolley, patient dignity out the window. you have to examine them.

You either bring like... Right. You'll either bring big curtains around and then that blocks the whole corridor so no ambulances can bring anyone in. And it's horrendous. You can't think too much about it because you just wouldn't want to do it. And when I walk through the hospital, I have my eyes on the floor. I can't bear to look people in the eyes because, you know,

they're like your family members. mate, it's shocking. And the waiting room's completely full. There's, you know, patients in every chair. Relatives are asked to leave because there's no room for them. People are like, you know, on the floor. You know, this isn't happening like every week, you know, it isn't out every day, but it happens every week where it's, and everyone, you come in and it sounds like I'm dissing the staff here, but the complete opposite. Everyone is that you work with. Trying their best. are just doing an amazing job.

And they, you know, they deserve these pay rises that they're striking for because they're striking for the future, the profession, to work within this environment. You know, they deserve, deserve to get some, yeah, to be paid. You know, we can't afford to pay them what they're worth, but let's give them at least. Something, yeah. Yeah. Wow. It's interesting to hear you talk about it like this because whenever I'm asked a question

about our health care system sucking, everyone's like, we got to switch over and be NHS. And I'm like, I understand why not worrying to pay for something would be a burden off someone's shoulders. But at the same time, there's problems, new problems that will arise that we have to fix. And here, at least, anything that the government does, like the frequent example we give here is our Department of Motor Vehicles, DMV, where you go to get your license, car registration, all these things. It's terrible.

because when the government runs it, they run it, no one cares, no one shows up, you can't really get fired. It's very laxadaisical, so no one cares. Whereas if you go to a corporate company, they're like on top of it, there's metrics, because it's financial, so they want to make sure it's optimized. So I'm like, oh my God, if we just go to a full nationalized healthcare system, seeing how bad anything that the government fully handles is terrible, what happens here? I don't know what that answer is.

It's scary. So do you have a solution for anything? I think I don't know what, yeah. You're like, raise taxes, give us more funding. Yeah, I mean, I chat to this to my mates. Like they come, how is it? Ed? And I'm like, it's horrendous. And then they're like, well, what can we do? And it's like, I don't know. I literally don't know. Because everyone's trying their best, like, I think one of the issues is that the social care needs to be sorted out. Like, people come into hospital. For example, if you have an elderly patient that's come in, maybe they've got a urine infection, they're a bit confused. They are the sole

carer for their partner that has dementia. Suddenly that's two people coming into hospital. They're not safe to go home. They've got no support package at home. They've been struggling for maybe two years and this is like crisis point. Maybe that's contributed to the illness. They come in, they assess from a medical point of view. These patients are maybe waiting on a trolley for a day or two in the ED, then they find a ward. Then they get medically optimized. The, the husband as well is, you know, got a bed. And then we can't get them home. We can't discharge them from hospital because it's not safe. It's not safe. They'll just bounce right back. Right. There's no, to try and get the care put in and assessed, it just takes so long. Like a sub if you

rehab or something. Yeah, right. Those things exist, but it's all just so backed up. Yeah. And what happens is so the hospital beds get full up, then it kind of goes back to ED. Right. And then so as soon as as it's busy in A&E, people like, what can we do about it now? It's like the problem was three weeks ago. Exactly. It's, you know, there's nothing we can basically do now. We also have, I mean, we see a lot of people with, with mental health problems as well. Yeah. You know, community mental health is under massive strain as well. And, and GPs as well. They're getting a lot of flat. They're getting a lot of flack. And I think the general public are kind of turning against them because they're struggling to get appointments. And I think they almost like blame the GPs. Yeah. Like work harder,

take more up more patients. Right. And the GPs, my friends that work as GPs, it is just horrible for them. They're seeing far, you know, more patients than they ever seen. And it's quite easy I think being an emergency doctor is you can go in and take and kind of leave and your work kind of goes because you hand over the patients you're worried about or the patients you've been discharged they've kind of gone to the family medicine doctor there's no follow-up yeah and that is that stress you know you worry about people but there's not the responsibility but for GPs for that have a caseload or people that are community nurses or community mental health workers when you have a caseload of people that you're responsible for and the case is growing. People have more complex

issues. They're not getting treatment. It's, I don't know how you live with that chronic stress, having that responsibility. Yeah, it's hard. Speaking of chronic stress, you know, I kind of wanted to do a segment where we do ER versus FM. Ed and I may share similar views on health care and make similar YouTube videos. We do have one major irreconcilable difference, our specialties. I practice family medicine where Dr. Hope works in the emergency department. So we stepped in the ring to defend our specialties and see who really has it harder when they go into work. What drove you to go down the path of ER, EM, as opposed to a different specialty? Yeah, I love the variety. I love the fact that I don't deal well with chronic stress, like stuff that builds up. I don't like having loads of

stuff planned in the future. I like going in. Solving it. Yeah. I love the teamwork and aspect. And that's probably why I didn't choose something like family medicine because I like working with like lots of different people. So yeah, they were the main draws. But I honestly loved every area of medicine I tried like when I was doing that. I thought they all had really interesting things about them. So yeah. What about you? Well, family medicine, I felt fit my skills well in that I liked interacting with people conversing, having a good conversation. I think that helped a lot when it comes to educating someone about their health or helping them come to a decision. Also, like you, I loved every aspect of medicine, so I couldn't see myself specializing in one system

because I felt like it would kind of disconnect me from the rest of the body. And the number one thing is the continuity. Like the thing that you say is stressful and maybe even dislike, I found really rewarding in that if I, on day one, have some sort of sort of intervention for a patient about their lifestyle, 10 years later, I could see the benefits of the change that I made 10 years ago, and it allows me room for celebrate or to see the work that was put in. Or, for example, I delivered a child, that child is now my patient. They're six years old, and I'm watching them grow, and I was the one that facilitated the process. That's really rewarding. So you're seeing more generations now. You've been in long enough to see. Yes, yes.

There was actually a family I talk about them quite often who, they were, some of my first patients that I saw as a young training doctor, and they were having trouble conceiving a child. The father was on a medicine for his prostate, and that medicine actually had some sexual side effects for him. We changed the medicine, got him on a different one. They were able to conceive. I delivered the child. The child is now my patient. So I'm like, this is like crazy to have this whole thing. It brings it back to when there was one doctor in the village and they did everything. Yeah. Right. I mean, it's kind of the opposite at A&E. We see people when it's gone wrong again.

It's like, oh, you're back with your, you know, going into DCA. Yeah, right. It's like, welcome back. Yeah, I mean, the number of times patients say to me, you know, thank you. I hope I never see you again. That's like a general patient quip, you know, happy to not see patients. Yeah, that's great. I don't have to see you.

So I've got, I write some notes actually about what's good about emergency versus. You need that too. Look how much more organized you are. But I think, but I can't come up with it on top of my head. So, I mean, I thought it was more of a challenge, right? Okay. A challenge to come up with things that you love about your field? Well, no, no, not a challenge. As in, I thought I would have to prove that emergency is better.

Let's hear it. Do you know what I mean? I'm going to fight it right now. Yeah. I'm getting my box. But just so everyone knows, this is a joke. Okay. No, I'm not going too hard.

No, I want you to go hard. I don't want to get clipped. I want, you're getting clipped. We're canceling you after this. Okay. You've canceled me at one point. I'm canceling you. Who do you think is cooler?

Okay. John Carter, Dr. John Carter. Yeah. From ER. Yeah. Not the caveman guy from that. I didn't watch that. Yeah.

That's it. Not him. Who's cooler? John Carter or Dr. Phil? That's not a fair collaboration. A comparison because Dr. Phil is not a medical doctor. Yes, I know. John Carter.

There you go. See? Emergency medicine, better. Okay. GP training in the UK, three years. Six years emergency training. Oh. So what's harder?

Twice as hard. Twice as long. Twice as long. Yeah. So there's that. That's like a Vago commercial. Yeah. Twice as hard.

Twice as long. Yeah. I thought here, the environment I thought you win on, actually. Oh, okay. Why is that? Because ED's not as nice, I don't think. Okay. In terms of what? Like, quality of life? No, in terms of like working in that environment. I think the actual... High stress? Yeah, maybe.

A lot of burnout for ER doctors here. Right. In fact, a huge percentage, not majority, but a huge percentage of ER doctors end up swapping to an urgent care model because they burn out after 10 years of working in an ER. Right. And urgent care, are you familiar with that model? Yeah, but it's, I think, creeping into the UK. Yeah, it's actually quite shit here in the US because it's turned into a financial model, more than a medical model.

Like hedge fund companies are investing in large groups that run these urgent cares. Okay. And they essentially were supposed to act as an intermediary between a, general practitioner's office, a family medicine doctor, and an ER. So you cut yourself, you have a giant open gash, you don't need to go to the ER, but your family medicine doctor has no appointments today, only tomorrow, you go to the urgent care. So it's supposed to fit that gap. And who staffs it? Either FM doctors or ER doctors. Anyone can really staff it as long as you have a medical degree or train. But what it has become is the young person's

I only need medicine when something goes wrong model. So now they don't have primary doctors. They just, whenever they have something wrong, they go to their urgent care. They see the doctor. They send them out with the incorrect treatment, the huge majority of the time, because they don't know this person well, or they overtreat because the patient is paying for this out of pocket most of the time. And they say, if I'm paying out of pocket for this, I want something.

You told me I have a virus, but I want an antibiotic. And to make sure that they have good reviews for this company, they give them whatever the person wants. So it's a very shady model, not a fan of it at all. So I think those are going to come back to haunt us in the US. Yeah. I think the way people, exactly what you say, people are interacting with healthcare differently. And I think it's because society has changed in a way. Like we are used to getting an Uber like that. We are used to, so people, grocery delivery, yeah. People interact with healthcare like that, which is not the traditional model. I think, I'm not blaming, people. That's just society. So we kind of need to move, you know, how can we get that? I know I know in

the UK lots of like telemedicine is happening now, like companies, you know, GPs are working. And these are all private. I mean, you know, teleconferencing and stuff happens within GP practices now. It's exploded since the pandemic. But private companies offering this. And I think a lot of the time, young people, they're happy to spend that just for the convenience. Yeah. But that's not always ideal. I mean, I have sometimes a telemedicine appointment, and it's like, I have stomach pain. How the heck am I supposed to diagnose a stomach pain without a physical exam? It's like, it's not going to be a good diagnosis. I'll be guessing.

Can you just put the camera? Yeah, but even then, like, I know, I know joking. It's hard. And they've even come up with some tools where you have like an otoscope that you can put in your own ear. Love it. And I'm like, God, this is going to end in a, or like a stethoscope you can put on and listen to it. Perfect. Brilliant.

Endoscopy. Yeah, exactly. Why not? We need to think ahead. Like, I've heard, like, people, you know, put in, like, haptic suits and stuff like that. I mean, come on. I think it's too far. Yeah.

Right. I mean, don't fix what ain't broken. Exactly. That's not the broken part of the system. Yeah. And now I'm starting to see all these companies that are like, oh, chat with our doctor and get a prescription for erectile dysfunction or hair loss or this and that. There's no chatting with a doctor. It's bullshit.

It's, say that you have hair loss. And check off boxes that you don't have these other problems and we'll send it to you. But you're not getting a real evaluation. I can't tell you how many men have come to my practice asking for erectile dysfunction pills. And I found that they were diabetic and we actually saved their lives by starting to treat their diabetes. But now those people are just going to go on this website, get their erectile dysfunction

pills and stay with their diabetes. Undiagnosed. So it's not ideal. And I think the pendulum is swinging a little too far and we've got to guide the pendulum back to the middle. A little homeostasis is necessary. like it. All right. What other jokes do you got? Well, they're not really jokes. They're just... Facts. Yeah. So I actually put this into chat GPT. Oh. I said, you know, what's better? And I said to

chat GPT, can you compare them and use some cultural references? Okay. Okay. And it said, it was very kind to emergency medicine. It said that emergency medicine doctors were like the Avengers, sort of swooping in, saving the day. It said if you need CPR, you. You're you should find an emergency doctor. And I was like, well, that's not true. Anyone, as you know, as you preach a lot? I mean, you don't want a dermatologist performing CPR. I think anyone could do it.

Yeah, I know they can, but if you have to select, you're not like, give me the pathologist. Yeah, maybe we do it more often than a pathologist. But, you know, it doesn't take an expert to do the CPR. Okay, it helps, you know, go on a course definitely. But it's in hospital, what we do compared on the street is very, Well, I'll put it this way. You don't want on an airplane emergency a dermatologist standing up saying I'm a doctor. Right. I'd rather an emergency room physician. I think we, um, the funny thing

is out in the public, if there's a cardiac arrest and we did a CP, you know, had to do CPR. Obviously, I'd be the one on the chest. In, in the sort of A&E, it's the most junior person goes on the chest. You know what I mean? But it's like, I think it's people feel like it's the people, you know, that's how you say likes, all the other stuff. Well, it's the same thing with like blood draws. They're like, oh, I want the doctor to do. I'm like, no, you don't. You want my nurse who does 50 of them in a day.

Who's an expert at babies? It's the same thing, actually, when people come in because they can't into A&E, when they can't get an appointment with a family medicine doctor. Like, oh, I've had this thing for a while. I'm like, you, and they think that we know more. But this is a thing that like, we're hospital doctors. Yeah. You know, we must know more than a family medicine doctor.

And you're like, you don't, no, they are experts in seeing this stuff. We are, you know, very, very, it's a specialism. It's become very specialized, yeah. Yeah. Okay. And then it said, so it said, we're like the Avengers. Oh, my God. Is it going to give something bad to me?

No, it said that you guys were like the sidekicks. Yeah. Are we your sidekicks? Yeah. They said they're reliable and stable. They're like the friends of the Avengers. That's terrible. I know.

I'll send you the clip so you can. I'm going to sue chat GPT. Are they suable? You'd have to ask them that. They'll probably give you an address. Because that's ridiculous. They call the sidekits. I know.

Unbelievable. So yeah, that was the chat GPT. And do you know, I think this. I think it's great. Although it did put me as a female doctor on chat GPT. It did? Yeah. When you searched your name you?

Yeah. Is it Dr. Mama Jones? She wrote, who are the top female doctors on YouTube. And I would think number four. Oh, so great. Interesting. Yeah. Maybe chat GPT is not 100% accurate.

Yeah. Or maybe it knows something about me. I don't. Oh, my God. You think it knows that much. It's like, you know, the TikTok algorithm, some people say, like, it led them to question their sexuality because it started showing more of the opposite. And then they're like, oh, maybe this is what I really want.

That does freak me out, though, these algorithm things. Of course. It must, what it knows about you. I mean, the whole AI, we're just talking about this. Like, it's the scariest thing on the planet, because if it learns that fast, how useless are we going to be? Unless you can code or fix code or fix a computer, you might be useless. And I think I've been sleeping on it a bit.

You know, I didn't think it would be here now. It just suddenly arrived in the last year. And it's now just, obviously, they've been using it a lot. in research and, you know, in these social media apps for a while, but it suddenly feels like now it's at your fingertips. There was a breakthrough and now it's exponentially exponential. Yeah. It's scary. I don't like it. So what else have I got here? I mean, I think that was it really. Okay. Oh, I put we've got cool gadgets. Ultrasound machines. We get to intubate people, we get to reduce fractures. Well, you know, what's interesting is, like I, for example,

don't work inpatient, but that's simply because of my choice. A lot of my colleagues see patients in hospital. Yeah, right. So they spend half the time outpatient. So they're doing a lot of these things, too, in hospital. It really depends on your scope of work. Like, there's family medicine doctors in Alaska that are like delivering babies, performing minor surgeries. Like, there's a, there's a broad spectrum to FP. But in the UK, it's not like that, right? GP is strictly GP office space. Yeah, it's GP. I mean, obviously this is tongue in cheek. I have lots of respect for my GP colleagues.

I think it's one of the hardest, hardest jobs to do. But yeah, lots of GPs I work with day to day. We always have a GP in the hospital I work at for, you know, I think part of the reason because people are using the healthcare system differently. And also it's, you know, they're great to have a diverse set of skills available. So, yeah, we have an urgent treatment centre associated with our hospital. And then, you know, at night we have one GP.

And so, yeah, it's a collaborative effort. And I think they really enjoy it as well because they get the team aspect. And also must be frustrating sometimes. Like, I need a chest x-ray for this patient that's come in. It's kind of useless. I can do a few bits. But it's like they can get it there and then and, you know, get blood taken and stuff. Yeah, it's sometimes it's messy where I have a patient coming in with like a questionable

pneumonia or something like a fracture. And I'm like, okay, go to get an x-ray now. I'll stay a little late to get the result or I'll have my resident and follow up overnight. It's like, it's messy sometimes. But you could figure it out and make it work. I wouldn't say that's the issue. I feel like our biggest issue is a finance issue.

Can patients afford their care? Is the cost of it fair? And a lot of times the answer is no. Even if they're insured, sometimes the answer is. Really? It's also messy. For example, if a patient comes in and they're, let's say their neck hurts.

And I'm like, when did the neck pain start? And they said, was in a car accident three weeks ago and the neck of pain never got better and I want to do some rehab I'll see them do the visit I'll say he needs a physical therapy maybe a muscle relaxer whatever something and I send it to their insurance insurance said hey in this note you said they were involved in a car accident we're not paying for this his car insurance should pay for this and the car insurance like but he filed it late filed it late so I'm not paying for this and they start arguing amongst each other or they'll be like oh he was in a car but

the patient was driving to work. This should be a worker's insurance. So it's not clear in that sense. We definitely don't have that. But my biggest issue is the quality of the care we provide. I feel like we always, for the most part, it's safe, but it's not what people deserve. That's for me the biggest thing, the NHS.

We have that same problem too. Don't worry. There's a lot of mistakes. No so comial infections and this and that. It's very messy. Okay, so you and I are going to fix it. Yeah, cool. We'll start our own nation.

We'll call it Avengers and Sidekick. And we'll give the best medical care. Love it. I just don't know who'll pay for it, but maybe our YouTube ad sense can pay for it. That is a hell of a model. I mean, this is getting Mr. Beast territory now, isn't it? Like, you know. A self-funded hospital.

I'll pitch it in. Basically, sure, sure. Just sign here. We're going to live stream your endoscopy. Yeah. And we'll pay for it. Yeah. Put it on Twitch. Hi, welcome.

We're entering the stomach now, going around the duodenum. That's Amina. That would be a captivating television. Wow, okay.