Socialised Medicine Again…

Unlucky for me, I have had another up close and personal experience with the “evil incarnate” that US public opinion raised me on of socialised medicine.  Paul Ryan’s recent comment about “death panels” have made me again desire to speak about my experiences.

The last time I had an up-close and personal experience was after I fractured my eye socket in a biking accident on holiday.  This time, it was the less interesting occurrence of a kidney stone, and not just any sort of “mild” kidney stone, a kidney stone that had me reeling and withering in so much pain, I went to the A&E (ER for you Americans).  It was an interesting comparison because I had gone to the ER about 13 years ago when I had my first one (only after it had passed though and caused some damage on the way out).  So I feel uniquely positioned to compare and contrast the two experiences.

I arrived in the A&E about 11PM on a Thursday.  There was some poor kid coughing is his head off, with tears streaming down his eyes.  I figured I must be in the right place.  There were a couple of other random people waiting in the waiting area.  So far, no “death panels” in sight, thankfully.  Maybe they were taking a break.  Anyways, after a few moments of standing there in excruciating pain while the poor lady looking after the kid had to explain that his parents had had to return to South Africa for two weeks and they had only recently moved up to Scotland and he was staying with them while his parent’s were abroad.  While this all happened a nurse had come out and collected him and shuffled him off to the back to start treating him.

Finally once the poor accidental guardian of a broken kid provided his information it was my turn.  A couple of quick words, because I was already “in the system” the receptionist said take a seat and someone would be with me.  I guess because I wasn’t bleeding and appeared to have all my limbs, I had to wait about 10 minutes for a nurse to see me.  The nurse practitioner called me into a side room to triage me, asked me a few question.  Because of the type of pain and having had a kidney stone 13 years ago and a very mild one recently, I was pretty sure what it was, but who knows, maybe I small animal at imbedded itself in my insides and was gnawing away.  She was obviously convinced I needed to be “seen” more properly and made me go wait out in the waiting area for another few minutes.

A couple minutes later she called me back and put me into one of the bays in the A&E ward.  At this point the pain was as worse as it had been and I was getting a bit delirious, having a hard time breathing and sweating quite a bit.  It seemed like things were taking forever, but looking at the clock, it had been about 20 minutes since I had shown up in the A&E.  Finally it was time to gown up and wait for a Doctor.  The nurse said that she could give me some pain relief, but until I had passed some fluid and they had analysed it, the only thing she could offer was a suppository version of an analgesic.  I thought about it for about 10 seconds, hopped up on the table and dropped my pants.  There is pain and then there are kidney stones.

I had to wait another 15 or so minutes after being violated by the lovely nurse.  It seemed, placebo effect or not, that the edge had been taken off the pain, so while I couldn’t even begin to think of sleeping or concentrating, I at least wasn’t going to go mad, which is where I thought I had been headed.  A lovely doctor, who introduced herself as a student doctor, came in and asked me some more questions, poked and prodded me and pretty much confirmed that it was serious.  She put an IV into my arm incase they needed to put me on some sort of drip as well as take some blood samples and then she said she was off to consult with one of the Consulting Doctors (UK terminology for “the real doctor”) and I was able to provide a urine sample.

Nursed popped in every once and a while to take my blood pressure, temperature and heart rate.  Eventually the “real” Doctor showed up, they having screened my blood and urine.  The good news was my blood was fine, bad news was that there was blood in my urine and protein, which indicated that I likely had a kidney stone.  She indicated that I would probably need to spend the night in the A&E and go for scans in the morning.  She saw that I was rather uncomfortable with this and suggested that she could give me more pain medication (orally thankfully this time) that was a bit stronger and see how I responded in 30 minutes.  By this time it was about 01:30.  I said OK and was given some of the “hard stuff”.

30 minutes later, I had started to doze off, while I was far from out of pain, I had dropped down to about a 6-7 out of 10, more than enough to start to drift off.  Seeing how well I was doing, the doctor agreed that I could go home and told me that they would call me for my scans between 09:00 and 10:00 to tell me when to come in that day.  She gave me some more pain meds (all prescriptions are free in Scotland, so there was no paperwork at all for me to sign, nothing to do but grab my meds, call a taxi and head back).

This is where I got worried that this was all “too good to be true”.  In the US, my one trip to the emergency room went at a similar pace (except I wasn’t just handed my prescriptions, I had to take them to a pharmacy to get them filled) but it was years (literally) of dealing with all sorts of “suppliers” to the ER chasing down every bit of the paperwork between me and the insurance company.  It seems that they somehow some of those claiming in the ER had gotten my address slightly wrong and the insurance company denied those parts of claims, so they came after me.

So I was worried now that I wasn’t in the care of the A&E, I things could be that efficient and my previous experiences must have been wrong too.  About 09:35 I got a call from the scanning department at the hospital, they wanted me to come in at 12:45 that day and told me where to go.  I said sure and showed up on time, where the receptionist found me quickly on the system and told me to go down a hallway and take a seat outside the CT scanning doors.  A nurse/technician came out to talk to the old man sitting next to me and said “oh, you must be Mr. Kelly” when seeing me, to which I replied in the affirmative.  She said “oh it will be just a couple of minutes”.  Again, I thought she must be wrong, that they can’t be that efficient.  Sure enough, about 5 minutes later (5 minutes after my appointed time) I was brought into the CT room, ran through the scanner and then escorted by the technician to  an X-Ray bay, because the doctors in the A&E wanted some X-Rays too.  She said that the results would be sent to the A&E and I just needed to go back there, check-in and one of the A&E doctors would tell me the results.

I went back to the A&E, explained myself and they found that I was in their “waiting to show up again” pile.  They had me take a seat and I waited about 45 minutes to see a nurse, where the first little inefficiency I saw happened, where she didn’t know what I was there for, until I told her and she said said “oh, ok, well, I will get one of the doctors to look at your results”.  I waited another 20 minutes and one of the doctors (yes, to you Americans, you might be surprised to find doctors actually come and get their patients in the UK) comes out to escore me to a bay and then tells me that the I have a couple of stones, that they are no longer blocking the urinary tract (which is why I wasn’t in that much pain by now) but they likely would need to be removed.  She prescribed me a couple more types of medication to help me and went off to get them for me.

Again, I walked out of the A&E, prescriptions in hand, having not signed a single thing or paid one penny.  I know that not all experiences are as good as mine, but I think in a lot of ways it is what you get used to and so the bar gets raised.  While there are cost based evaluations of treatments and not all treatments get approved, like some experimental cancer drugs that haven’t been proven to significantly improve survival rates or quality of life, which I am sure makes a big deal to those who are affected, I think in a civilised society, you shouldn’t every have to worry about if you will get treatment for the things you need.

Be you rich or poor, seeing a doctor, getting your medication and having your health looked after is a right as a member of British society.  I don’t understand why many Americans don’t see it that way.  Many effectively say “no system is better than an imperfect system” or they don’t want to “pay for those who don’t pay into the system”.  That seems ludicrous to me.

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