Alistair Cooke’s ‘Letter From America’ was one of those radio programmes which was a regular feature of my childhood. Fifteen minutes, once a week on BBC Radio 4 was part of my parents’ routine listening. Cooke was a British journalist who settled in America in the 1930s and while remaining very British, became part of the establishment in the US. He mixed with the great and the powerful over a period of about 70 years. He viewed America through the objective lens of a foreigner noticing all its idiosyncrasies and strange foibles. The subjects of his 15-minute sketches were varied: ‘The Verdict of the OJ Simpson Trial’ and ‘The Senate Trial of Bill Clinton’. I also remember him discussing the ‘extraordinary American health system and contrasting it with the NHS’.

All I have in common with Alistair Cooke is that I am writing this as a foreigner in the US. A holiday in Naples, Florida is opening my eyes to some of the differences between us and our American cousins. I love America and the Americans but some of their ways and customs are, to say the least, unusual to us Europeans. For example, their healthcare system and relationship of ordinary citizens with the medical profession seem a little bizarre.

‘Trust Your Face To Me’ – so proclaims a full-sized hoarding beside the highway, ‘Dr Patrick O’Flaherty MD is the most qualified cosmetic surgeon in the Naples area and thus is worthy of such trust.’ ‘The Best Orthopaedic Surgeon in the Joint’ exclaims another hoarding, extolling the skills of a knee and hip replacement man with large white teeth and a marvellous head of hair. Obviously our Medical Council rules do not hold here. Family physicians don’t seem to have large roadside advertisements but are nevertheless far from modest in their online advertising. One such doctor has, we are told, won three awards: The Compassionate Doctor Recognition 2011, Patient’s Choice Award 2011 and Castle Connolly’s Top Doctors 2013.

A few days ago we took a short guided cruise down the Gordon River, out of Naples docks towards the 10,000 Islands and the mangrove forests. Our captain was a colourful character who gave a commentary on the enormous holiday mansions lining the river. The first impressive and palatial dwelling with surrounding manicured acres had a powerful motorboat moored to its jetty. The letters on its fine transom spelled ‘Bone Bender’. “What do you think the owner of that boat does for a living?,” asked our skipper. “Well, he’s one of our best orthopaedic surgeons, specialises in knee replacements”. 

Just upstream were two enormous motor yachts, ships actually. One had the name ‘Top Dog’ and the other was simply called ‘I Got This’. I guess these simply reflect the characteristics necessary to realise the ‘American Dream’. When I get home I shall have to rename my small boat which is disappointingly called ‘Sea Saw’.

The last mansion we passed was the huge holiday estate of vice president Joe Biden. The previous day it had been announced that his son had tested positive for cocaine and was being ejected from the US Navy. So, despite the apparent gulf of privilege and wealth, that family are experiencing some of the same emotions that many of my inner-city Dublin patients have felt as addiction and substance misuse upset life and health.

Since my last visit here, the pharmaceutical industry has stepped up their TV advertising direct to the public. One advert is for a new diabetes drug which shows overweight individuals enjoying activity and fun and asking one another how their ‘A1cs’ are doing. The message is to “ask your doctor about whether this new drug will help you reduce your A1c?”. Talk about undue influence.

I have noticed some large pharmacies which sell and dispense medicines but also sell liquor and cigarettes! In one such drug store we found a bargain basket of tablets all for 88 cents a pack, including a bottle of omeprazole 20mg.

Speaking to people about healthcare reveals a feeling of powerlessness in the face of a very large, private health industry only accessible to the wealthy or insured. One couple seemed to feel helpless with regard to care for their mother with Alzheimer’s; they have no idea about occupational therapy and seemed unaware of old-age psychiatry. Another English lady is hoping to return to the UK after 23 years with increasing ill health. She is still paying off a $36,000 bill for a four-day admission to hospital three years ago when she underwent some bowel surgery.

We look forward to the last few days of our holiday with such friendly, open and welcoming people. However, more than ever we realise that our own creaking public health service is definitely worth saving and must be enhanced.