Mohammed Saeed
An ophthalmology clinic is recognisable almost anywhere. The investigations used and the principles of assessing patients and planning management are largely the same. Discussions around treatment options also follow a familiar pattern, with patients and clinicians coming to a shared decision together. As a medical student in the UK National Health Service (NHS), most of my clinical encounters had followed a similar structure, yet my time in Abu Dhabi made me increasingly aware of the differences in how care can be delivered. I attended an ophthalmology elective at Cleveland Clinic Abu Dhabi (CCAD), a hospital established through a partnership between Mubadala and Cleveland Clinic in the United States (1). The healthcare system in Abu Dhabi is built around mandatory health insurance, with government-funded and employer-funded schemes operating under central regulation (2,3).
Perhaps the most immediately noticeable difference was the organisation of outpatient clinics. At CCAD, I observed attending ophthalmologists working between two examination rooms. While the attending assessed one patient, another was being prepared in a separate room. Visual acuity, imaging and other required investigations had often been completed before the attending entered. The result was a different rhythm to the clinic. Rather than the physician remaining in one room and waiting for each stage of the patient’s visit, the physician moved between patients who had already undergone much of the preparatory work. Although this was new to me, redesigning outpatient ophthalmology pathways to improve patient flow has also been explored in the literature (4).
Another notable difference was the regular use of medical scribes, who drafted consultation notes for the attending to review. Documentation consumes a significant proportion of an ophthalmologist’s clinical time, with one study in a found that it accounted for approximately 38% of the time spent per patient (5). Another study of nearly 30,000 ophthalmology visits found that scribes reduced mean physician documentation time from 7.6 to 4.7 minutes per note, although overall visits were slightly longer (6). In the UK clinics I had attended, clinicians generally completed their own consultation notes, with dictation used more commonly for clinic letters. UK ophthalmology also increasingly relies on multidisciplinary working and extended roles for optometrists, orthoptists and nurses (7,8). The approaches may look different, but the objective is similar: allowing ophthalmologists to focus on aspects of care that require their expertise.
I also noticed a difference in how episodes of care could be organised. At CCAD, I frequently observed multiple stages incorporated into the same appointment rather than each appointment having one specific purpose. Where appropriate, patients were assessed, consented and underwent a minor procedure during the same clinic visit. However, this model depends on sufficient staffing, equipment, procedural space and flexibility. It cannot simply be reproduced by asking clinicians to do more within an already full clinic.
The most unfamiliar experience I had was observing the role of health insurance in clinical practice. I saw clinicians communicating with insurance providers to justify or obtain authorisation for investigations and treatments. In some consultations, the treatment options available to patients also appeared to differ according to their level of coverage. For selected patients, I saw highly specialised options, including gene therapies, discussed where clinically appropriate, although I cannot comment on how often these were ultimately authorised or provided. The NHS approaches healthcare organisation differently, with access principally based on clinical need and services predominantly publicly funded (9). For me, this was simply an interesting observation of how different healthcare structures can influence the delivery of otherwise similar clinical care.
Another interesting feature at CCAD was the international workforce. I worked with attendings who had trained across the world, including North America, South America, the UK and Europe, the Middle East and elsewhere. Although the NHS also has an international workforce, I found it interesting to observe the similarities and differences in the training that the attendings had received. During multidisciplinary team discussions, clinicians could bring different experiences and perspectives to treatment goals and management options. For me this came along with new approaches to medical training. The importance of an internationally recruited workforce in Abu Dhabi has also been described in the literature (10).
For a medical student, all of this created an unusually interesting educational environment and a new perspective on the delivery of healthcare. It made me think more about how patients move through a clinic, how clinical time is used and whether certain stages of care could be organised differently. I realised that clinical training, institutional culture, available resources and patient expectations all interact to shape how care is delivered. My time at CCAD did not convince me that one system had found the ideal way to deliver ophthalmic care. Rather, it made me question some of the routines I had previously taken for granted, and perhaps this is the greatest educational value of an international elective.
References
1. Cleveland Clinic Abu Dhabi. Cleveland Clinic Abu Dhabi: A year of providing complex and critical care for the community (Internet). 2016 Mar 17 (cited 2026 Oct 16). Available from: https://www.clevelandclinicabudhabi.ae/en/media-center/news/a-year-of-providing-complex-and-critical-care-for-the-community
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