Friday, February 03, 2012

You get what you pay for-- sort of.

So, I  had to have a surgery this week. It was related to a recurring problem that I had to have surgery for about 5 years ago in the U.S. (though not as invasive and extensive as that U.S. surgery which knocked me out of work for two months). While this one was just a minor day surgery, it underscored the marked differences between a private vs public health care system.

When you say private, people automatically go to "expensive." So why is that in the public system that I now live in, I actually pay significantly more than I did when I lived in a private system? Yes, people-- that's because public-- or social, health care isn't actually free. It's funded by taxes-- my taxes. The way the system works, the higher your income is, the more your taxed (for everything, but that includes your health tax). This goes to pay for not only your own health care, but everyone who can't afford to pay for theirs. That's the idea behind a social health care system. Do I fundamentally believe in this? Actually, I do. I agree that the people who have more can afford to (and should) give more. But as a consumer, I also believe that I need to get top quality and excellent customer service for my money. And here, I don't (though this isn't exclusive to the health industry by any means).

The other problem with this system is the people who can but who don't. Meaning-- the millions of people who are "on the dole" (claim benefits and income support in this country) who are fraudulently claiming public assistance (and thus, not paying taxes). Arguably there are people who need these benefits-- the frail and elderly, the mentally ill or disabled. But there are plenty who do not. Believe me-- a lot of them live in my neighborhood. So my tax dollars are not only paying their rent, for their cars, their childcare, their take-out, their pub outings and their 40" flat screen TVs, but also their health care. That, I have an issue with.

My recent hospital experience was markedly different from my U.S. experience. Keep in mind. It actually personally cost me MORE in the UK than in the U.S.

  • Months of in-depth consultations with my doctor (also my surgeon) pre-surgery so that I fully understood the procedure and the risks / benefits
  • Once the surgery was decided upon, I picked the date that was convenient for me (I asked for a month out so I could prep work for my being out; but could have had it the next day if I wanted to)
  • All tests are scheduled and completed in one day(well, 20 minutes in fact)
  • On the day of the surgery, they were waiting for me, everything prepared
  • Met with the doctor pre-surgery to go over any last minute questions or concerns
  • Was introduced to the surgical team who would be looking after me-- nurses, medical students, another surgeon, anaesthesiologist
  • Went into surgery-- 6 hours later in recovery, doctor sat with me to go through the results and what was done
  • Taken to private room (with lake views and wifi-- but that's just a bonus)
  • 5 day hospital stay in which a doctor came to see me at least 2 times a day, a nutritionist planned my meals (though I also had access to room service whenever I wanted it), nurses were in and out actually taking care of me
  • When it came time to leave, a discharge planner met with me for about 30-45 minutes to go over very detailed printed instructions, my medications, my prescriptions, things to watch for regarding infection and also the date and time for my follow-up appointment at my doctor's office the next week (and weekly, appointments for the first 4 weeks after surgery followed by a final appointment before going back to work. All scheduled in advance).

  • Primary care doctor refers me for testing
  • One month later I get my appointment for blood tests and ultrasounds
  • One month later I go back to my primary care doctor who refers me to a specialist
  • Two months later I see specialist
  • Specialist has not received test results, so orders new tests (rather than getting the ones that I have already had done)
  • One month later I get the appointment for the new test-- another month out
  • A month later I get an appointment to discuss the test results with the specialist 
(NOTE: There is no choice when it comes to appointments. They send you a letter in the mail telling you when you need to be at the appointment, If, God forbid you have a job, or kids and can't drop absolutely everything to be there on the appointment time and date, you're basically screwed. Yup-- it's another month-- or two-- until you can get back in. They don't take kindly to you not doing as you're told. When you have to change it because you're traveling, have client meetings or, I don't know, in California for Christmas, they get pretty high and mighty and you get delayed another few months).
  • More tests because they couldn't see what they needed (on the day the ultrasound technician could have made that decision and tested a different way, but health care professionals are not empowered to do so). Another month.
Are you beginning to get the picture?

From start to surgery, it was about 16 months. Yes, people-- nearly a year and a half. Sure, it wasn't life-threatening, but I did have a time sensitive issue (driven by government restriction for a specific treatment because of your age). Even still-- the experience and sheet frustration with the system (not to mention utter waste and expense-- I had to repeat the same tests five times for various reasons... some of them having to do with sheer laziness in my estimation).

As for the actual surgery and hospital experience? 14 hours for a less than one hour surgery.
  • Hour 1: Arrive at hospital. Wait 4 hours to be taken into surgery. In this time I had a 5 minutes or less each with: 1) the nurse 'who would be taking care of me for the day' (this was the only time I saw her). She officially "admitted" me to the hospital by confirming I was who I said I was (though no ID was required); 2) my doctor who would be performing the surgery (confirmed who I was; asked if I had an questions, ushered me back to the waiting room because she's very important and busy); 3) the anesthesiologist.
  • Hour 4: Walked myself into the operating theater; Sat on a gurney for another 30 minutes waiting; Given drugs to knock me out.
  • Hour 5: Woke up in recovery room; Wheeled to ward-- 4 others in the room with me.
  • Hour 6: Nurse came in and said the doctor didn't need to see me because "everything went well." I'd get a letter with an appointment in a couple of weeks for a follow-up. (Whaaa??? Ummm-- no, "this is what we found, this is what we did, you're going to be great??") She then informed me that when I drank something, ate something and peed I could leave.
  • Hour 8: They brought me some water.
  • Hour 9: I rang the nursing station to tell them I needed to pee, and ask if they need to measure or make sure I did? (No)
  • Hour 10: I asked if I could be discharged. They asked if I'd had something to drink (yes), peed (yes) and eaten something (no). Ummm... that is because I wasn't brought anything to eat?? "Would you like something to eat?" Ummmm... YES. I'm freaking starving because it's 4:00 p.m. and I haven't eaten anything since 8:00 the night before.
  • Hour 11: They bring me toast. I wolf it down.
  • Hour 12: I ask again if I can be discharged (yes). Can someone take my IV out so I can leave (yes... in about an hour).
  • Hour 13: I change into my clothes, IV stint still in place.
  • Hour 14: Nurse removes stint and tells me I can go. Ummm.... discharge plan? antibiotics? pain medication? things to watch for in case of infection?

Apparently not. I was instructed that I could take up to 400 mg of ibuprofen for pain (that's 2 pills people). And then they wished me a good evening (well, not really-- I wished them a good evening) and we walked out. On the ride home I consulted WebMD and a couple of other websites to do some reading on post-surgery care for my condition and to inform MRN what he needed to look for in case I had a raging infection that knocked me unconscious. (That didn't happen, but I'm just saying).

Yes-- public health care is BRILLIANT. (that was sarcasm in case you didn't pick it up).

So for my money, I'm paying more for horrible service, really poor (and I would argue, completely irresponsible) quality of care where the patient is treated like a number who doesn't really need to know what's going on, and year-long waiting times. Freaking awesome.

Disclaimer: My lawyers (if I had them) would tell me to include this: This is my personal experience with the U.S. and UK health care systems and it does not reflect the views or experiences of any person, company or organization other than myself.

Thursday, February 02, 2012

Coconut Willie...

... lives in a tree!

Oh, how this record (yes-- as in vinyl... I'm that old) brings back memories. AB and I used to lie on the floor in our bedroom in Hawaii and listen to "The Adventures of Coconut Willie and Pukahead" over and over and over again. Who is Pukahead, you ask? The magic menehune, of course! It's probably one of my earliest memories... though, I'm sure it's muddled with several others of listening to this and our Disney record collection ad nauseam over the course of many years (and boy did our older sister love us for that).

Alas, I could not find the original Jack de Mello version. Though, lucky you-- I did find Aunty Genoa Keawe singing a version of it on YouTube (disclaimer-- she's not my aunty; that's just what Hawaiians call elders, whether they're related to you or not). You gotta love YouTube.

They come to Waikiki-iiii. They come to Waikiki to see his opu swing!