July 12th, 2017
You Might Be an American Physician Assistant in the U.K. if …
Somewhere between figuring out what foods classify as puddings* and learning how to make the physician assistant (PA) role work within the National Health Service, my colleagues and I find that we have arrived at our 1-year anniversary of working in the U.K. As I reflect on both the successes and struggles of adapting to life here, my overall thought is how far we’ve come and how much we’ve grown, both professionally and personally. I would like to look back at some of my own growing pains with a segment I’ll call:
“You might be an American PA in the U.K. if …”
- … you never call anyone by the correct title.
I had heard before coming to the U.K. that (male) surgeons historically styled themselves as “Mr.” and not “Dr.” The use of this title dates back to the 1700s and earlier, when surgeons wielded a knife but did not necessarily have formal medical training in the form of an M.D. Fast forward many years, and surgeons are M.D.s and are admitted into the Royal College of Physicians, but they’ve kept the “Mr.” title as a point of professional pride. Knowing this, I was still surprised by the array of titles. For example, I work for four surgeons in the gynecologic oncology department. They are professionally titled, “Mr.,” “Dr.,” “Miss,” and “Professor.” “Miss” does not indicate marital status. “Dr.” can also be a surgeon. I am still not completely clear how the “Professor” title works. Beyond doctors, head nurses are “Sisters” and the senior head nurse is titled “Matron.” These titles do not indicate gender. While I’m on the topic of titles, the CEO of my hospital has been knighted and therefore is a “Sir.” I had the pleasure of meeting him, and he introduced himself by his first name, which I respectfully ignored in favor of saying “Sir Andrew” — because how many times does an American girl meet a knight?
- … menial tasks all of a sudden are incomprehensibly difficult.
Like opening doors. One of three buttons needs to be pressed before you can open it. Pro tip — it’s not the green one. That is an emergency switch. I may or may not be speaking from experience. I’m also remembering my first attempt at dialing a number on a U.K. telephone. “Do I just type these numbers?” I asked. “Like, all of them??” My mobile number has 11 digits, 13 with the country code. “Is that a busy signal or is it off the hook?” And you’ll need either a manual or an incredibly patient work colleague the first time you have to bleep (that is, page) someone.
- … you are suddenly a terrible speller.
I knew that in the U.K., some words were spelled with an added “u” that we don’t use in the states — colour, favourite, humour, etc. I was not prepared for all the other added letters. For instance, the “o”s — oestrogen, oesophagus, diarrhoea (the “o”s are silent, by the way), and the “a”s — gynaecology, orthopaedics, anaemia (“a”s also silent). Then there are the “s”s instead of “z”s — modernise, realise, organisation. Maths is plural. Sport is not. Probably easier to just accept that you are going to confuse all of these and often use American spellings in British patient charts, and British spellings when you email American friends, and everyone is going to think you are a really bad speller. Which now you are. Welcome to life as an expat healthcare provider.
*Answer: Puddings = desserts, in general. Except if you are talking about a Yorkshire pudding, which is a type of puffed pastry served with Sunday roast. Or if you are talking about black pudding, which is blood sausage that is usually served with a Full English breakfast. None of which are American pudding.