Ben Collins talks to Sarah Dobbs, General Practitioner, about the 'Nuka' system of care they use in Alaska.
This video was filmed while Ben was in Alaska as part of his research for a report.
BC: Sarah, you’re an English national, a GP who was trained and then worked in the NHS. Can you tell the folks back home what’s fundamentally different about working as a Family Doctor here in comparison to being a GP in England?
SD: The model of care delivery is very different here. We have the whole structure of… I work as a member of a team which is very different from anything I’ve done in Britain, and we’re right next door to the hospital so referrals and working with our colleagues in the hospital is fundamentally different here to anything I had in Britain. In the NHS, I worked in my own little room and people came in to see me and at the end of the morning, I would sigh and rush out and have a whole massive paperwork and try and delegate a few things. Whereas here, I do everything as I go along. So my team involves my Scheduler, I have a Medical Assistant – something called a CMA – who brings the patients into my room and measures their vital signs, and I have a Case Manager and I think the Case Manager’s absolutely vital to everything I do and she is central to my life. So that’s my own personal team, and then I’m part of a bigger team.
We work in a clinic and in the clinic, there’s a Pharmacist. So if I have questions about medication, I can go there straightway and he’ll hope with dosing and side effects and medications. So that’s incredibly helpful. We have a Dietician and with the problems with Diabetes and Dietary issues, we can call on them immediately after I’ve seen a patient or a customer owner and we have a Behavioural Health Consultant – a kind of a Counsellor – and as we all know, most… a lot of medical problems have a psychological basis so it’s incredible being able to call on that person after a consultation because I think it’s important to do things immediately and if you refer someone and they have to wait for several weeks or months, that problem has gone.
BC: Now you know both systems. Do you think that the model of care that’s been developed here could be easily transposed to the English system?
SD: I think there are ways that it could be used, but I think it would pretty difficult to actually transpose it completely because the way that patients are seen are very different. In Britain, patients come in to see the doctor. Whereas here, the doctor goes in to see them and because the doctor goes in to see the patient, they then take their work back into the communal room to finish it off and write up their notes, their charts, and when you’re in that environment, that’s when you actually go out and you use… you find the support staff. That’s when I find my Behavioural Health Consultant. That’s when I find the Dietician. That’s when I speak to my Case Manager. So it’s that immediate feedback after seeing the customer owner that we don't have in Britain that is vital and I think essential to the work that we do here and I don't know how one could do that in Britain when you just have ten minutes per patient.
BC: So I guess what you’re telling us is if we want to adapt the system, we need to make some pretty fundamental changes.
SD: I think that’s right. Yes.