Welcome to the USA(‘s Medical System)!

Enjoying the Bathroom Floor of the Hilton Garden Inn // Missing the Triad Conference // Credit Card Healthcare vs Socialist Healthcare // Thank God for Lovely Longwood People! // I ❤ the NHS

Well, I don’t think I could have planned for the start of my time in the USA to have gone any worse! I will spare you the gory details but I managed to pick up a stomach bug/food poisoning almost immediately upon entering the USA on Sunday and have only just started to feel better again, after a particularly unpleasant week.

I managed to miss my presentation and the graduation ceremony, as well as almost all of the conference activities through the week. I was so poorly that on Thursday I actually had to go a doctor!- which, as you know, is a matter of national shame for a British person. Well, it was certainly an interesting cultural experience, and an expensive one. I can safely that I wouldn’t swap the NHS for the world, no matter how slow it can be. Since this medical experience was a big & bizarre learning experience, I thought I would share it for those that are, like me, both fascinated and horrified by private healthcare. Don’t worry, I won’t include anything about my bodily fluids!

So, on Thursday morning, wonderful, wonderful Janet from Longwood Gardens took me to a walk-in doctor’s clinic near the hotel, which is something like a GP surgery- except that you don’t have to be registered and anyone can go there. The first thing they did was ask for my ID and Insurance Card, and give me a form to fill in which was all about my insurance details and also giving my consent to treat me. Of course I don’t have an insurance card and although I have travel insurance including medical and had the details with me, none of my information tallied with what they wanted, so that was very confusing. When I eventually got through that, I had to pay $125 before I could have any treatment. Of course I felt like I was dying, so it was all a bit much really.

Once I’d handed over my credit card, I only waited a minute before I was called in to be seen. A nurse took my vitals and history and a urine sample and then a doctor came in to see me. The doctor asked me all the same questions again and examined my stomach. She ordered an IV drip and a load of drugs, and some nurses came in to bring them to me and to take blood samples. This was all pretty much the same as the UK and no one was politer or nicer than at home- the nurses were very nice but the doctor didn’t really listen to me, was in a rush and didn’t explain anything well, just like doctors in the UK. The main difference was that everything happened very quickly, and I was hooked up to an IV within 30 minutes of leaving the hotel. [Side note: an IV drip makes you feel WEIRD!]

After the IV drip had finished, the doctor came back to examine my stomach. It was still very sore and tender, despite anti-inflammatory drugs, pain killers and the extra fluids so the doctor recommended that I go to have a CAT scan to check whether or not I had {insert a load of scary-sounding medical terms that I didn’t understand and therefore can’t remember}. 

At this point everything totally spiralled out of my understanding and previous experience. Apparently it makes a difference in many standard US health insurance policies where you have a doctor-recommended test. That is, for many people, their insurance would cover a CAT scan if it was done in A&E but not if it was done in an out-patient clinic, even if the same doctor referred them for the same reason. Crazy. Of course, if we went to A&E  we would have to wait a long time, and then go through the diagnostic stuff over again, so I had to phone my insurance company in the UK and speak to them to find out if it mattered to them. It turned out that my travel insurance doesn’t ‘pre-approve’ care, meaning that I have to pay up-front and then submit a claim afterwards and I might get the money back or not, depending on what they decide- unless the costs are above £500, in which case I’m not sure what: the doctor has to call them get their approval before treatment? I don’t know. Unfortunately, my mobile phone credit ran out halfway through the conversation, so didn’t find out. I had already managed to elicit that they didn’t care where I had a CAT scan, only that they wouldn’t say for definite that they would pay for it, so the doctor agreed to find me an out-patient appointment.

Once that was decided, everything became (if it’s possible) even more confusing and I was extremely glad that Janet was with me to translate/make decisions. The doctor wanted to know where I wanted to go to get my CAT scan, and there were about a million different options. Of course, I didn’t care- it never would have occurred to me to have a choice and indeed, I didn’t want one! I just wanted someone to tell me what to do and for everyone to just shhhhh and let me lie still. Janet and the doctor had what seemed to me to be a long and quite heated discussion about where was the best venue, and the choices seemed to depend on location & convenience (from mine & Janet’s point of view), the type of machines (from the doctor’s point of view), where was known and had a good reputation (from both Janet and the doctor’s points of view- which didn’t match), where was easy for the doctor to deal with (from the doctor’s point of view). The doctor wanted us to go somewhere in Delaware because it was easy for her to make an appointment there but Janet said no to that (it was far away), then the doctor tried to make an appointment at some other place but got cross and slammed the phone down because it was too complicated for her… It all seemed very difficult! Eventually a solution was found and an appointment made, with the added bonus that we were able to collect the required barium sulphate solution from a pharmacy (which, again, we had to choose) and I was able to drink it before going to the hospital, rather than going there 2 hours in advance of the scan.

So, we left the clinic, went to pick up the other Triad Fellows (who had been having fun at Wal-Mart), picked up my barium sulphate and went to Longwood- where we were moving into our houses. I had a couple of hours to access the internet & phone the insurance company again (N.B. instead of lying on the floor and resting, like I wanted to), and drink my barium sulphate before Janet came back to get me for the CAT scan. Barium sulphate, by the way, is the most disgusting thing known to man- particularly if you have been vomiting or unable to eat due to nausea for four days. It was like drinking white emulsion mixed with pina-colada flavoured poison. Several pints of it. Luckily the doctor had given me an anti-puking drug otherwise there was no way I could have kept it down. I was swearing a lot, and obviously severely doubting the necessity of a CAT scan for someone with a stomach bug.

After I’d swallowed all the evil brew at the correct times, Janet and I drove off to the testing place. It was a very new and swish facility just down the road that was built for all sorts of scans, x-rays, ultrasounds etc- very convenient. Once we arrived and signed in, I was called to a special booth to register, i.e. hand over ID, discuss insurance and money again. For some reason, the fact that I was a ‘self-pay’ meant that I didn’t have to pay the standard cost of $1600, I only had to pay $472.41. I have no idea why, but we checked this multiple times and the nice woman behind the desk assured me that the total cost was $472.41. So I handed over my credit card again!

I also had a hilarious conversation with the woman, who wanted to ask me some questions about the UK’s socialist healthcare! Yes, really! Ahahahhahahahahaa! I’m afraid that I wasn’t gracious and I did laugh at her. I think the term Americans use to describe the NHS is socialised healthcare, although of course that’s not a word we would ever use and doesn’t really make sense. The nice lady mainly wanted to know about whether or not we pay huge amounts of tax to pay for our ‘socialist’ healthcare, as she’d been told. When I explained that the amount of tax you pay depends on how much you earn, and that different portions of your salary are liable for different % of income tax (and some is tax free), she could not believe it. It seems that Americans pay more tax than we do! They pay a flat rate of 30% income tax on all earnings (which obviously is much better than our system for wealthy people, and much worse for the majority), plus they have state taxes and annual property taxes and school board taxes and all sorts that I didn’t understand. Where does it go? Not on public transport or public health care, obviously. AND they ALL have to file a tax return every year. Wowsers.

After this amusing interlude, I went to have my CAT scan, which was unpleasant (the die they inject into you makes you feel like your skin is melting) but very quick and efficient. And then home to Longwood!

Of course, the CAT scan was totally unnecessary, as predicted: the IV drip and whatever those drugs were made the difference to get me on the mend. By Friday I was able to eat actual food and I am now a fully walking & talking human being again- if still a little shaky and bruised from the whole experience.

Overall, the care I received was very efficient and quick. It was definitely more invasive than that I would have received in the UK (I’m pretty sure my GP would have told me to go home and drink some dioralyte) but it did the job of getting me better, for which I am grateful. Apart from the money issue, which was very stressful, the biggest other difference from home was that I was obviously expected to be very well versed in medical terminology etc. It seems that americans are much more knowledgable about all aspects of medical care than I think we are in the UK, from drugs to diseases, methods to management. In the UK, I think our attitude is that the doctor will just tell us what to do and that’ll be the best thing, but the system here requires a far greater degree of self-management of your treatment: you really have to understand what’s going on to negotiate the insurance, myriad of different venues and options for care etc. I suppose that could mean that you get better care but really it is hard work when you are at your most vulnerable. Next time I’m ill, I’d like the NHS to just come and look after me please.

2 thoughts on “Welcome to the USA(‘s Medical System)!

  1. Enjoyed your blog! Had similar experience when I worked in US – too much choice! However, as long as you had good insurance (mine was gold-plated) you were treated like a zillionaire.


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