Spot the difference

July 2007

A man walks into a doctor’s surgery in South West London, under extreme pressure from his wife-to-be, to get his allegedly high blood pressure looked at. The surgery smells like all doctors the length and breadth of the UK – a heady mix of two parts flatulent old lady, one part Brut aftershave, and one part child’s vomit (three day vintage). The scene is like something from a refugee camp in war-torn Uganda, with the sick of the area having wheezed, oozed and staggered their way into a waiting area so large that the end-of-season football playoffs could conceivably be played there.

Stepping over the wounded to get to the cinder block reception, the man stands for five minutes waiting for Doris to finish her conversation with Patricia about the size of Mr Harris’s piles. No, not Mr Harris from Watling Close – the one from Ridgemount Drive who was having the affair with the hairdresser from Belmont Hill. You know, the one with the hoop earrings who’s already on her third marriage?

Eventually Doris turns to the man and asks which of the seventeen doctors he’s here to see. Once he’s been redirected to the reception on the other side of the room, and endured a similar delay while he waits for Mabel to discuss last night’s episode of Heartbeat with Sandra, he eventually checks in and scans the room for somewhere to sit.

Our hero uses both hands to lift and move the beer gut occupying the last remaining space in the room, wiping off some unidentifiable residue from the orange plastic seat as he does so. Wedging himself into the seat alongside the aforementioned Beer Gut, he ducks quickly to avoid a flying red plastic Fisher Price brick which has ‘accidentally’ ‘slipped’ from the hand of the five year old convict-in-waiting to his left.

On the table ahead of him lay three magazines. Having rejected a copy of Hello magazine from 1994 (featuring Mandy Smith on the cover) and Weight Watchers’ 101 Low Fat Classics, he plumps for a relatively new (only four years old) copy of Top Gear magazine. Sadly, the cover is merely masking an issue of Coeliacs Monthly, the new publication for intestinal disease sufferers everywhere. He wearily puts it down and forces himself to read an informational pamphlet on the warning signs to look out for when you’re having a stroke.

Forty five minutes later, the man is convinced he has at least three symptoms, although the pain running up and down his left arm could conceivably be caused by the angle at which he’s having to hold himself to avoid resting his elbow on his neighbour’s man boobs.

Finally, an announcement over the loudspeaker informs him that it’s his turn to see the doctor, and gives him a lengthy set of directions to get to the relevant office. Given that the PA system is now 43 years old and replacement parts are no longer available, the muffled instructions (to head down the corridor, take the first right, and then the fourth door on the left) are unclear, and our hero spends the next ten minutes inadvertently interrupting old men having their prostates examined before finally managing to track down his GP.

July 2008

A man walks into a doctor’s surgery in New York’s SoHo, under extreme pressure from his long suffering wife to get his allegedly high blood pressure looked at. He takes the liftelevator to the second floor, and quietly remarks to himself that he wishes Americans would accept that it’s really the first floor. Stepping out of the elevator, he walks past a gentle waterfall that takes up an entire wall in the corridor that leads to the reception desk.

Eva Cassidy’s version of Sting’s “Fields Of Gold” plays gently across the loudspeaker as he approaches the desk. The receptionist looks up, smiles and asks how he is. By name. Having extracted a $20 fee (or “co-pay”, as she calls it) by credit card, she asks him to settle down in one of the chocolate brown leather sofas nearby. He is the only person in the waiting area.

Healthcare free at the point of entry vs extortionate health insurance. You pays your money (or not), you takes your choice.

I still had to wait forty five minutes with eight year old magazines as my sole entertainment, though.

14 thoughts on “Spot the difference

  1. Karen

    This is one of the reasons I love paying such high taxes here in Iceland. 😀 For the amount of times I have to use it, it is pretty cheap, not long waiting times and we even had a broken collar bone to deal with!

    That being said, there are a limited number of doctors for a growing population, so you must call pretty much on the button of 9am to get any chance of an appointment that or the next day. Unless you want to pay extra for going after 4pm..

  2. Alasdair

    Jan – you are either not-serious – or your last experiences with the NHS were in the early ’70s or further back … or you are badly in need of help of the psychiatric kind …

    Back in the ’60s, GPs made housecalls … the NHS was a good working mixture of medical care professionals …

    Now, a hospital can get fined large amounts of money for not making its patients wait for long enough …

    The Real NHS

  3. Jan

    Alasdair, I don’t know where you are from as you choose to remain hidden. But you are wrong. I lived in England until 1995 and was perfectly happy with both my doctor and my dentist, and all the health care I received under the NHS.

    Even today, my father has a lot of health issues,and the NHS has been brilliant. I’m glad he lives in England and not the USA, because I know he would not be able to afford the same health care here.

    Also I have a friend who died because the US system didn’t treat him because he was uninsured. His friends paid to fly him back to England, unfortunately, it was too late by then.

    If you went to England and became ill, doctors there would treat you, irrespective of insurance, because they abide by the hypocratic oath, not an insurance claim.

    BTW, when did doctors stop making house calls here? Because doctors in my area were still making house calls in the 70’s 80’s and early 90’s.

    Perhaps you are the one in need of psychiatric help if you think the high cost of American health care is acceptable. Either that or you don’t live here, so you’ve no bloody idea what you’re talking about anyway.

  4. Alasdair

    Jan – my first 21 years were in Glasgow, Scotland and on the West coast of Scotland … then 4.5 years in Montreal, then the Los Angeles are where I now live with my lady wife (coming up on our 30th anniversary on the Opening of the Grouse Hunting Season – the Glorious Twelfth!) … thus, I can directly address UK healthcare up until 1975, from personal experience …

    Doctors here abide by the Hippocratic Oath – my wife is one such … she was in private practice until a side-effect of neck surgery effectively deprived her of the use of her left hand … given that it’s a tad difficult to be an Ob/Gyn when one cannot use a catcher’s nitt effectively, she is now retired from practice – and volunteers and teaches …

    With that said, had you actually taken the time to READ what I typed in my comment, rather than emotiuonally reacting to what you believe you read, you would have foudn that, contrary to your belief that “If you went to England and became ill, doctors there would treat you, irrespective of insurance, because they abide by the hypocratic oath, not an insurance claim.”, the article I cited pointed out that a recognised Hospital was fined over 2 MILLION pounds sterling because the Hospital didn’t make its outpatients wait at least 122 days before seeing a consultant.

    In case you hadn’t realised that last reference in my prior comment was a clickable URL, here it is again – The Real NHS – where you will find that Ipswich Hospital was fined because they didn’t make outpatients wait at least 122 days – that’s ONE HUNDRED AND TWENTY TWO DAYS – to see a specialist doctor … the HMOs over here in the US are blatant, but they are not quite *that* blatant about delays …

    Here in the US, if you have a broken leg, that will be treated in pretty much ANY emergency room whether you are insured or not … if you have no insurance, you can go to your local County Hospital and you will be treated to the best of the ability of that County Hospital … without being told “Go away for at least 122 days” …

    One of the major reasons that healthcare in the US is so expensive is because of a legal problem … in the UK, the legal system is “Loser Pays” – if you sue someone and you lose the suit, the defendant is entitled to recover his/her legal costs … in the US, if you sue someone and you lose the suit, the defendant is stuck with his/her legal costs …

    So you get lawyers filing nuisance suits, knowing that it is often cheaper to settle for $20K rather than run up 50K in legal costs successfully defending against a nuisance suit …

    My wife’s malpractice insurance premium during her last year of Ob/Gyn practice was over $220,000 – she had to pay that directly just to be able to practise her specialty …

    In the US, you are uninsured until you are 65 unless you get health insurance through your employer or by paying for it yourself … at age 65, *everyone* is eligible to be covered by Federal Medicare … which covers everyone up to its ability to do so, given the enormous amounts of monies that go to the various lawyers and administrators …

    You didn’t say what your friend’s health problem was – if, however, it was acute, he would have gotten treatment at his local Couty Hospital … if it was chronic yet urgent, then, if he was flown to Ipswich, he had better have had more than 4 months to live, or he was equally out of luck in the UK system …

    Yes, the US system can be a whole lot better – it will take the controlling of the legal parasitic infestation before that will happen, unfortunately …

    There are many good and skilled and caring lawyers in this country – unfortunately, the ambulance chasers and the like are a way-too-large number, and they have a lock on the current Democrat Party (major donors are the then “trial Lawyers’ Association, recently renamed to try to hide their activities) and that has kept Tort Reform (ie trying to get “Loser Pays” instituted) from being passed in Congress … that’s why Hillarycare’s best efforts were to try to add yet another layer of administration to the already-baroque systems of US healthcare … end even with a Democrat White House, Democrat Senate, *and* Democrat House of Representatives, Hillarycare failed to get enough votes to pass …

    People like your friend will continue to slip through the cracks not because “he was uninsured” but rather because so much of the resources which *should* go for active healthcare are siphoned off for adminitrative and legal stuff which often actively gets in the way of good skilled caring doctors (like my wife) trying to honour the Hippocratic Oath …

    In case you hadn’t guessed, Jan, not only do I have a good idea what I am talking about, I care deeply and personally about it, for myself and my wife, for my 4 daughters, and for everyone else currently stuck with less good care than this country could fairly easily achieve if its healthcare resources could be used for actual healthcare …

    And I am embarrassed that the UK, via NuLab, can be such blatant wretches as to permit the obscenity of what was done to Ipswich Hospital to happen … it is embarrassing that NuLab implemented its own version of Hillarycare when the US Congress was smart enough to toss it out !

  5. Jan

    You’re right Alasdair, I didn’t realise there was a link in your post.

    This is a quote from the article

    Jan Rowsell, a spokesman for Ipswich Hospital, said that no one needing urgent or emergency treatment had been affected by the rule.

    “Anyone deemed to be clinically urgent would be seen earlier. This rule is there for people who are waiting for planned surgery.”

    And from you:

    You didn’t say what your friend’s health problem was – if, however, it was acute, he would have gotten treatment at his local Couty Hospital … if it was chronic yet urgent, then, if he was flown to Ipswich, he had better have had more than 4 months to live, or he was equally out of luck in the UK system …

    So perhaps you didn’t read the article too closely yourself.

    My opinions regarding the NHS are based on my own and my family’s experiences, not on newspaper articles. My father recently spent 2 weeks in an NHS hospital and his only complaint was about the food.

    I am not knocking the doctors and nurses in this country, they do an admirable job, and are more than adequately compensated for it, even taking legal considertions into account. I just think that any system that depends on funding from bottom feeding insurance companies is not healthy.

    We will never agree, Alasdair, so we may as well agree to differ. 🙂

  6. Alasdair

    Jan – if you want to go “anecdotal”, then consider that *my* family’s experiences of US Medicine are mostly positive … (we’ll leave the Health-Net weasels out of it, thankyouverymuch (and, in fairness, prior to asking them to live up to their promised flexibility, even HealthNet gave good routine (bad-food-hepatitis) health care)) …

    Nice to know your impartiality, tho … “I am not knocking the doctors and nurses in this country, they do an admirable job, and are more than adequately compensated for it, even taking legal considertions into account. I just think that any system that depends on funding from bottom feeding insurance companies is not healthy.”

    From direct personal immediate-family experience, way too many doctors are way-less-than-adequately-compensated for being on 24 hour call 7 days a week …

    As for the health of a health system, given a choice between a fully-included government-funded health system like Cuba, or a “system that depends on funding from bottom feeding insurance companies “, I’ll go with the one that has the significantly-better outcomes, lower infant mortality, longer life-spans with quality of life – and that is the latter …

    Oh, and I will agree with you on one thing … we are not likely to agree on this – most likely because I *work* for one of the LA area hospitals – on 24/7 call … and my pager went off most recently this morning, an hour and a half before my alarm was set to go off … and I will continue to rank on the merit of outcomes, not emotional beliefs …

  7. Alasdair

    Jan

    I can understand why you would have been “content to let this matter drop” … since you weren’t being permitted to change the subject, the next best place to take a losing position in a discussion is to hope it goes away …

    Slate.com is a number of things, but it is NOT news … editorialising, yes … biased editorialising, absolutely, yes … and you decided to go with one which supports your world-view … all fully underatandable …

    Interestingly enough, the Slate.com editorial you cite has some fascinating points …

    “or have pittance-paying Medicaid “ – this, of course, is the fault of the “system that depends on funding from bottom feeding insurance companies “, isn’t it ?

    What’s that you say ? Medicaid is the US equivalent of the NHS … fascinating … and that is what you think will be better …

    And the article writers’ best solution, the one they want to leave you thinking about ? “And let’s also hold congressional hearings on E.R. boarding. “

    I note that the writers blame the ER crisis on the evil hospitals – and manage to not mention how many ERs are closing due to insufficient reimbursement for efforts … after all, it’s corporations that are cruel and crass capitalists, and governments are good and generous givers …

    Feh !

    The same “In England, the National Health System now has a rule that 98 percent of patients have to spend less than four hours in the E.R.. “ mind-set ends up forcing busy ERs to move patients elsewhere just before the 4 hours is up – whether that is the best-indicated treatment for the patient involved … it becomes yet another governmental mandate to make the lives of skilled doctors more challenging in a disruptive way …

    I work with the integration of systems, getting disparate elements to work well together … and the current NHS is *not* a good example to follow …

    Check on outcomes … as with doctors, check on outcomes at different hospitals … when you find hospitals with better-than-average outcomes, work out what they are doing and have the other hospitals bring aboard the better practices …

    Rather than blame the corporations who own the hospitals for what happened in the cited example, how about spending more time asking WHY the various people who saw the lady collapsed, on the ground, apparently did nothing about her for an hour ?

  8. Jan

    Alasdair, your response here reveals better than anything how our opinions are worlds apart.

    You chose to analyze Slate’s report, where my concern was with the lady who died. You mention her as an afterthought, and YOU ask ME why people ignored her? She was in a hospital waiting room, for God’s sake. You tell me why people ignored her? On second thoughts, don’t bother!

  9. Alasdair

    Jan – forgive me for trying to point out that the Sainted NHS ain’t what it used to be …

    Had you said that you pointed me at the Slate article out of humanitarian concern for the lady who was ignored, I would have addressed that point … since you did it in a discussion about whether or not the NHS is a better set-up than the US sytem, I responded in the context of the discussion … silly me !

    To which end – here’s yet another current example of why WE DO NOT WANT THE NHS established in the US … it shows why we cannot afford to have the NHS established in the US …

    NHS latest ‘humanitarian’ efforts (It’s a link, in case you get confused easily)

  10. Alasdair

    Dylan – you may have to explain the term “jobsworth” to Jan …

    The people who left the lady lying on the hospital waiting room floor may well have been uttering the American equivalent of the classic “More’n my jobsworth to do anyfin’ abaht it, guv !” …

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