Monday, 11 October 2010

Don't Know How Good They've Got It

There are only half a dozen people in the waiting room when I go in. The receptionist smiles and apologizes. "I'm afraid there'll be a bit of a wait this morning."

"How long?" I ask, surprised.

She glances at her watch. "It might be as long as fifteen minutes."

Fifteen minutes? I feel like laughing out loud. Where I come from, the receptionist wouldn't even bother to tell you if the doctor was running only fifteen minutes late. When I was thirteen, I once waited an hour and a half in the doctor's office, shivering and sweating with a 104-degree fever. A friend in New York once waited over an hour to see a doctor, and she had a dislocated shoulder.

"I can wait fifteen minutes," I tell her. Fortunately I've brought a book and my glasses, but as I open my bag, the elderly woman across from me leans over to her friend and puckers her mouth as she stage whispers, "It never used to take this long!"

Her friend scowls back. "No, it didn't. Ten years ago, you got seen the minute you came in!"

They both shake their heads and give the receptionist a disapproving look. "It's all these new people coming in," the first woman says.

I find myself bristling at this: we've been in this town almost ten years, off and on, but we're definitely some of the new people. We could spend the rest of our lives here and this would still be true. You have to have been born here to be considered one of the town folk, and it helps if your parents and grandparents were too.

"How long have you been here?" the second woman asks. I almost expect the first woman to say We got here before the war, but she huffs and checks her watch. "Twenty minutes!" she says.

The second woman tuts at this and the two of them sigh and settle back for another wait in the clean, cheerful doctor's waiting room with its stacks of relatively new magazines, its comfortable seats, and its tasteful classical music playing in the background. Two minutes later the door whips open and the doctor calls one in. She gets up with an aggrieved look on her face. I'll bet the doctor is in for a chewing out.

My husband and I have lived in quite a few countries now, and we know what we're talking about when we say that the medical service here in our part of Scotland is tops. It drives me wild to hear people complaining about twenty-minute waits at the clinic when they can almost always be seen immediately. In a part of the country where the doctors still go on house calls in emergencies, it irritates me no end to hear people whining about the doctor refusing to come when all they have is a cold.

These people have no idea how the rest of the world lives. My husband spent a week in one of the best hospitals in Sudan and clearly remembers opening a door to a linen closet and seeing a stray cat nursing her kittens on a pile of laundered sheets. The cat, he learned, was a vital member of the hospital: she helped keep down the considerable rodent population. He had to walk 20 minutes to the hospital, shivering and shaking from malaria, because there were no ambulances. Aid worker acquaintances of ours in Uganda once decided to take the bus back to the town where they lived instead of continuing their journey across Africa: they had forgotten their yellow fever vaccination certificates and were told that they would have to be vaccinated. The doctor who would be vaccinating them had only one needle. He knew better; he had been waiting quite desperately for another consignment of needles; but he also knew that yellow fever was a more pressing risk than HIV at that particular point in time.

The United States has a well-deserved reputation for first-rate medical care, but I have never spent less than fifteen minutes waiting to be seen by doctors. Even in Japan, a country with generally excellent medical care, hospital and clinic waiting times are notoriously long and most people resign themselves to losing an entire morning or afternoon when they have a medical appointment. I once spent a miserable four hours in a Tokyo hospital lobby, trying to pacify an infant who was burning up with fever and had, I was virtually positive, German measles. "No problem," sniffed the receptionist when I urged him to give us priority, "we don't have an obstetrics department here." I pointed out that the most vulnerable people were women who might not realize they were pregnant, and that such young women were perfectly likely to visit the hospital for broken bones or head colds, but my arguments did not move him. When we first moved back to Japan with our new baby, our first pediatrician's office was dark, cold, and musty. The floors were filthy, the stuffing of the couch was coming out, and we always had to wait at least an hour. Our local hospital had a water fountain with a single plastic cup which was used by everyone. That has since changed, but I still remember when.

Here in Scotland, when our daughter had a suspected case of the flu, the doctor came directly to our house. A friend of mine had a mammogram which revealed a suspicious lump; within three hours, she'd had an ultrasound and a biopsy -- and a diagnosis of benign. "Sorry you had to wait so long to find out," the doctor actually told her.

The door opens and another elderly woman comes in. "I'm sorry," the receptionist tells her, "there'll be a bit of a wait today."

"No bother!" the woman says cheerfully, picking up a magazine, "I've got plenty of time."

I watch the woman sit down with a sigh of contentment as she pulls out her glasses and opens the magazine.

Perhaps she's one of the new people too. Or maybe she's lived abroad herself.


Anonymous said...

We once had to wait over half an hour in our pediatrician's office ... and when she came in, she told me to be thankful I had boys. She was delayed because she had to arrange an emergency hospitalization for a teenage girl with anorexia. (I still think someone should have thought to inform the patients who were waiting, though.)

Charles Gramlich said...

The doctor came to your house? wow. Here in our small town the wait is usually pretty minimal for general services.

e said...

America's health system is only good in cases of trauma or emergency. Otherwise, you wait 3 weeks for a prescription to be written and faxed, often don't get test results in a timely manner and don't spend more than 15 minutes in with the doctor. Quality often depends upon where one lives and whether one is able to pay exorbitant costs for insurance that still does not cover everything.

Anonymous said...

The local GP surgery where I used to live had a sign up saying "If you haven't been called within 30 minutes, please let Reception know." But waits over ten minutes were unusual ...

Of course, the best thing about the NHS is that it's free. No matter how many complaints end up in the papers, at least it doesn't cost. My mother had to get a routine blood test while on holiday in the US once, and we couldn't believe the sum which had to be disbursed - at least half of which, apparently, was for the cost of faxing the result back to her GP.

Nora MacFarlane said...

My care here in America is wonderful, even if I do have to wait 20 minutes for an appointment. It's rarely more than that. I am thankful.

angryparsnip said...

I guess the care in Japan is better now because at the clinic Daughter-in-law had their baby at was lovely, she had wonderful care stayed a week and had great food. Japanese son has waited some but usually gets right in.
Thank Goodness times have changed.
I don't know how you sat at the Hospital with a sick baby. I would have gone ballistic !

My doctors wait is maybe five minutes and test results come back pretty fast.

So like you I am very grateful for the care we can have and fifteen minutes is not a big deal. A good book makes time fly.

cheers, parsnip

debra said...

Anyone in the US knows how long the wait to see a doctor can be. Once, a long time ago, I was in an exam room with my young daughter. We had been waiting for more than an hour. When we finished the last magazine, and played the last game, I walked into the hallway, just as the doctor came to the door. "Great!" I said. "I was just going to fine you."

Miss Footloose said...

I've had long waits and short waits in doctors' offices everywhere. But it is true that in the US people (and I expect in many other developed countries) tend to complain more about waiting anywhere, or not getting what they want, or finding things too expensive or paying too much tax. It is hard to listen to the complaints when you've lived in poor countries and know how diffficult life can be for other people. It just sounds so wrong. Once you've gained this kind of perspective, you just look at many things in a different way.

Vijaya said...

I don't mind waiting either, Mary. I decompress, read a book or magazine, write a bit. It has never bothered me.

I remember house calls being made in India. Villagers bartered with chickens or grain. I also remember waiting at the doctor's office while the compounder (pharmacist) literally mixed up the vile-tasting medicines next door. But there was no preventative care per se. At school, we got our smallpox vaccinations en masse.

Here in the US, we are so lucky to have good medical care. We pay for it through my husband's work. I'm not sure free health care is the answer ... because people misuse it. But I wonder what it would be like to eliminate the middleman like they did in India.

Robin said...

Love this story! I find running late the most stressful part of my job. I think it's because I'm a mom, and I know that people have tons of things to do, and could spend their time in a way better manner. Since I don't overbook people, and I put aside circumscribed amounts of time, I'm usually pretty good. 30 minutes is my absolute worst. Then I apologize and grovel so ridiculously, that I usually have parents trying to comfort me. Just what they need. Sheesh.

Anne M Leone said...

Amen. Living in England, I am so thankful for the NHS and my local GP. I think my favorite part is being able to walk into any doctors' office in the country and have them serve me, no paperwork, no discussion.

When the whole health care debate was going on in the US, one of my British co-workers was amazed to discover something similar to the NHS didn't exist in the US. She said to me, "But how do you care for the poor?" She couldn't imagine a developed country functioning without universal health care.

Mary Witzl said...

Anne -- Only half an hour and she thought to apologize? At Kaiser Permanente Hospital in Fontana, California, two-hour waits were pretty much the norm and no doctor ever apologized. Complaints did nothing -- the receptionists were impervious, poor things.

Anorexia is one of the saddest, most perplexing diseases I can imagine, but I know pf at least two boys who suffer from it.

Charles -- The smaller the community, the shorter the wait, I think. Those grumpy ladies in the waiting room aren't all wrong; in big cities like Glasgow, you sometimes have to wait a long time to be seen.

Doctors still come to your house here, but the secretaries vet you hard to make sure you're really very ill first. But many people here take this incredible service for granted. They don't know what it's like to have to haul your vomiting, feverish, fainting self off to a clinic on public transportation.

e -- Although I know it varies greatly depending on where you live in the States, my experience has been exactly what you describe. There is also a real prejudice towards treating children which is, of course, natural, but it's very hard to see the middle-aged and elderly given second priority when they are genuinely in need of care. And when you consider that excellent care is free to all here, the sky-high insurance rates in America really seem unreasonable.

Emily -- They've got the same sign in our surgery here. It always amazes me, having come from a place where nobody gave a hang if you waited all day long in reception.

People who complain about the NHS here have learned not to do it around me unless they want a real earful. On one of our last trips to America, I had to fork out $120 for a visit to a GP who misdiagnosed my problem. Back in the U.K., I went to a GP who quickly referred me to a specialist and the whole thing was sorted out in less than a week. While the taxes are high, that's what I WANT to spend mine on. We would be doing very well to come up with a system half as good as the NHS.

Nora -- Be thankful! What state do you live in? (I won't tell anybody!)

A friend of mine in the Middle West said she only had to wait 20 minutes at her doctor's office. Wisconsin is way up there on my list of desirable places to live.

AP -- During the last ten years we lived in Japan, enormous changes were made in hospitals. The good hospitals used to be very forbidding and bleak inside. Now, they're cheerful and welcoming and you never see water coolers with one cup available for the entire lobby. It used to amaze me to see some coughing man drink from that cup and put it back, only for another person to pick it up and drink out of it.

I had my youngest daughter in a Japanese hospital. Even now I sigh to remember how delicious that food was.

Mary Witzl said...

Debra -- Good story! I feel sorry for the doctors, who are usually run ragged. But any system that keeps genuinely ill people sitting and waiting is in need of a good sorting out.

My mother and I used to wait in our local clinic for hours. She used to tell me her life story while we waited, just to keep me entertained. Another thing I remember was reading the better part of James Herriot's 'All Creatures Great and Small' during one particularly long wait.

Miss Footloose -- That is so true. If we could all have a good dose of the harsh reality so many people get on a daily basis, we'd be much less inclined to whine. On one hand, I think complaining can be effective -- no one should have to put up with the ridiculous insurance rates middle-class people pay in the States -- but on the other, we need to see what we DO have and be grateful for it. Medical care is generally good in the States, and the NHS is really great. We should look for ways to make them better, all while thanking our lucky stars we've got them.

Vijaya -- You have also lived in two different worlds, so you can tell people how lucky they are in the States.

People here abuse the NHS by asking doctors to come on house calls when they aren't really very ill, or seeking free drugs for recreational purposes. But having lived in a country with 'free' medical care, I'm 100% for it. When my first daughter was born in Wales, some of the women complained about having to buy their own diapers, cotton wool, etc. Everything else was free -- anesthesia, follow up care, heating, food -- so I shelled out for the toiletries and kept my mouth shut.

At my hospital in Japan, there was a sign in Japanese telling patients NOT to give doctors gratuities, that they would still receive decent medical care. Apparently, giving the doctors expensive gifts used to be standard practice if you wanted to be get the best medical care.

Robin -- You're on the other end of this, aren't you?

Most patients picture their doctors taking their time and messing around instead of hurrying to treat them. I used to work in hospitals and I know this isn't the case, but it's still nice for you to apologize when you're late!

Anne -- Isn't the NHS great? Sure, there are glitches from time to time, but I still can't get over the general quality of the care AND being able to sail out of the office without filling out half a dozen forms or parting with cash. It's especially wonderful when you've got kids to look after, but don't have to spend half your time struggling through paperwork.

Stella said...

I often wait an hour or two when I visit my doctor. I bring a book and a copy of the NY Times crossword puzzle. Sometimes I've been able to complete both of them before it was my turn to see the doctor.

I think you're right about the Brits and Scots not being used to waiting. My parents, who were originally from England, once took our boys to see the Statue of Liberty when they were small. They had to wait in line for an hour or longer. My mother complained that "Nobody even offered us a cup of tea."

Bish Denham said...

I went into an ER at a hospital with severe vomiting, it was about 5 or 6 in the morning. It took them until nearly 3 PM to get me in the OR when they realized my appendix had burst!

Pat said...

I can attest to the excellent medical care in Scotland. About 20 years ago my dear MIL spent her last weeks in the Western Hospital in Edinburgh and the loving care she received was as good as we knew in the fifties.

Mary Witzl said...

Stella -- When we lived in Japan, our house was too old to have an air conditioner installed. Summers were intensely hot, so I used to look forward to my weekly root canal sessions at the dentist's office. I would bring a book and settle down for a pleasant wait. It was noisy, but beautifully cool there, and there were no mosquitoes.

I sympathize with your parents: standing and waiting in line is a pain in the neck. But a cup of tea at the Statue of Liberty? They must have been bitterly disappointed in America!

Bish -- Dear God, what an experience! I'm glad they finally got you into the operating room, but I hope they had a very good excuse for taking so long to figure out what was wrong with you. A ruptured appendix is no joke!

Pat -- I'll make it a point to share that with people here. It just amazes me that people have anything bad to say about the NHS in this part of Scotland. I'd like them to realize what a generally good deal they're getting.

Robert the Skeptic said...

I remember when the doctor came to the house when you called. He had the alligator doctor bag and the head reflector mirror so he could look down your throat. My doctor even gave me his head mirror before he suggested I be removed from the couch and taken to the hospital for an appendectomy.

We have become accustomed to not waiting for anything in this society. It cracks me up that people complain about delayed flights. My parents were used to a cross country trip by train taking days to complete. We draw a new standard then judge everything by that expectation.

I like to say that if Paris Hilton's chauffeur shows up late, she probably thinks her life is ruined.

Chocolatesa said...

Lol those old ladies should try living here in Quebec! Healthcare is paid by the government but the waiting times are horrible and all the hospitals are understaffed. Ironically, emergency rooms are notorious for having the longest waiting times, if you have something less serious you're much better off going to a clinic.

I've heard many stories of people waiting 12 or even 24 hours in the emergency room with broken bones or other injuries. The longest I waited was 6 hours I believe for a sprained ankle, I wouldn't have gone but the nurse on the set insisted that I go and have it x-rayed in case it was fractured (to remove themselves from any liability I suppose).

At a walk-in clinic you can usually get away with a 3 hour wait on average. I was astonished to wait only an hour at a clinic once. No apologies or cups of tea offered, or expected.

If you have an appointment it's probably shorter than that, but it's so rare that I have one that I wouldn't be able to tell you really.

Se2 said...

Hey, I am new here, over from Kim's blog,..

I am doing my undergraduate in medicine from a state college in INDIA..SO by it, I am sure you can estimate what would be the waiting condition here...

Here, during OPD, you would find at least 300+ patients in the waiting room at any moment. And on an average, the doctor sees around 100-120 patients.

Even with private practice, it's not too good. Sometimes it's even worse. I mean, at my dad's hospital, i have seen patient wait for 3+ hours to be checked by him...!


here, 15 minutes wait would mean your lucky day..:)

Mary Witzl said...

Robert -- Those head mirrors doctors used to have were so cool! I could use one myself when I treat my cats for ear mites.

One of my earliest memories is a train journey my mother took with me and my two sisters when we were 5, 2 and 1 years old. We traveled from California to Kentucky and yes, it took days. My mother had to wash out two sets of diapers in the train bathroom, and I believe it was summer. Can you picture parents doing that nowadays? We've gained a lot of benefits and comforts, but I can't help thinking that it's made us soft and spoiled.

Chocolatesa -- Six hours is an incredibly long wait. Even I would complain if I had to wait that long. But you are right: the people who complain about having to wait for 15 minutes really should try living in a place where the waits are over an hour. Still, it isn't quite as bad if you're waiting for treatment that you don't have to pay for. It's insult to injury to wait hours for five minutes of the doctor's time, then have to fork out a lot of money for it -- and wait another hour in the line at the pharmacy.

If we ever go back to Canada, I will do my best not to get sick or injured!

Se2 -- Thank you for visiting and commenting, and how I wish I could share your experiences with the people who feel 15 minutes is an unreasonable time to wait.

Doctors in India see 100-120 people a day? WOW! I worked for a doctor in the States for several years and he was exhausted when his patient load was around 60 patients a day. In Japan, I've known doctors who saw up to 100 people a day, and they claimed that it was impossible to give consistently good medical care (or diagnoses) when the numbers went that high.

But 3 hours would be an average waiting time at a hospital in Tokyo. And when you do get to see the doctor, there are often other patients in the examining room. I can't imagine how the people here would cope with that!

Anonymous said...

Sometimes I wait a few minutes and at other times a few hours. Depends on the place. In one hospital I waited for hours, so I learned to go to a hospital with a much shorter waiting time.

Most of the doctors I go to are pretty prompt. I had to drop one yahoo who always came late and was overbooked. The last time he stood me up. I was a morning appointment and he never arrived.

Lily Cate said...

Ooh, I'm in Wisconsin!
I must say, it's lovely here.
We get a little bit of every season, and they're all beautiful.

As far as healthcare goes, it's pretty easy. Whenever there isn't time to fit in an appointment with our regular doc, we go to the walk-in at the same hospital. It's never more than 10-45 minutes wait. If you just need a prescription, you can get it right at the pharmacy, and if you need more care, you're already at the hospital.

Our problem is dental, which isn't covered by our plan right now (mr. cate works for a non profit that can't afford it, and neither can we) so we end up paying out of pocket, and its pricey.

Whenever I get annoyed with it all, I go to my kitchen and fill up a glass of clean, drinkable water, or open my cupboards and look at all the food I can make for my son whenever he's hungry, or look out the window at my car sitting in the driveway, and I'm instantly very thankful for the situation I live in.

adrienne said...

My mom fondly described a trip to Scotland as, "taking a trip back 20 years in time." It seems like service like that is a thing of the past in many parts of the world.

Mary Witzl said...

Medeia -- Getting stood up by a doctor is no fun at all when you're sick or hurt. But you're in a good place if you can get away with clinic waits of only a few minutes.

Here in our town, we don't really have the option of getting a different doctor unless we're prepared to pay a lot of money for private care. But I'm not complaining!

Lily -- From what I've heard of Wisconsin, you get more than a bit of winter, but I'd still like to live there. You live in an incredible place for spring and fall, though I do remember how surprised I was that the summers were extremely hot. If I had a job in Wisconsin, I'd move there yesterday!

It's interesting that you only have to wait up to an hour there, but you don't think that's a long time (and neither do I). People in this town would be writing to their local newspaper and members of parliament with their complaints if they had to wait up to an hour.

Our dental system isn't great either. But we've also got fresh water on tap, enough food, and adequate transportation, so like you, I think we're doing fine.

Adrienne -- In many respects, your mother is right -- when we first came here, I kept thinking I'd landed in a Disney movie from 25-30 years ago. But we do have a drug problem in Scotland, and there are loads of juvenile delinquents (called Neds here), and alcoholism is rife. And the Scottish eating habits could use a real overhaul, and I speak as a native of the Land of the Big Mac.

A Paperback Writer said...

I most certainly agree that a fifteen minute wait for the doctor in the US would be ridiculously short -- unless you're the first patient in the morning, in which case you still have to wait about 15 minutes because heaven forbid that your appointment should be when you schedule it!
And I do recall my pediatrician making a housecall when I was a pre-schooler and my brother had accidentally pulled my arm out of its socket. This would've been in about 1967 or 68. It's amazing that any doctor anywhere would make a housecall today. Wow.
I must say, however, that the service I got every time I used the medical center at the University of Edinburgh was much like using an Instacare here in the US. The wait time was about 30 minutes. It was clean and the doctors tried to care, in spite of the fact that they were always viewing complete strangers. When I had to have a suspicious mole removed and biopsied, the biopsy took four weeks for the results to be returned. I was also told that the staff was too busy to contact me with results; I would have to come in and check with them. The day the month was up, I went into the center to check. The results had come in that day. The receptionist looked at the chart and said, "No cancer." That was it. I had no chance to ask any questions of even a nurse. Naturally, I've kept careful watch on the spot where the mole used to be ever since, just to make sure.
My point of this lengthy tale is that I think your care facility in the smaller town is much better than what one finds in the larger Scottish cities. Yes, complaining about the NHS is a favorite pastime in Scotland, but it sounds like the complaints are more deserved in bigger cities than where you live.
Still, it's so far above and beyond most places in the world that we really have no right to complain much in the first place.

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Sorry about all that.
Blogger told me my comment was too large but posted it multiple times anyway.

Blythe Woolston said...

I really wish that more expats had been heard during the medical reform debates. But then, I'm not certain anyone reasonable could have been heard over the hysterical doomsaying.

And time is such a cultural variable. I about went nuts adjusting to leisurely waits for a cup of or a sandwich when I was in Europe. Once I caught on, life was fine.

I love my Dr., but I feel bad that he always seems to be figuring out how to out-maneuver the system that employs him.

Mary Witzl said...

APW -- (Blogger does that to me all the time!)

I'm glad that you had a fairly positive experience of the NHS when you lived in Scotland. I've heard stories of extremely long waits in big cities like London and Edinburgh, but as you know, we get those long waits in the States too. People say that we will never be able to have anything like the NHS in the U.S., but I can't believe that we cannot find a way to have such a system too.

The NHS is bad for waiting times for elective surgeries, which is especially hard on the elderly, for whom time is limited, but I still think it's a great system. If the whiners here ever went to live in the States, they'd come back to Scotland with an entirely different attitude.

Blythe -- I would love to live long enough to see something similar to the NHS in the States. If they managed it here, I can't see why we can't do it in America!

In Europe, you have to factor in the waiting time when you go out for dinner, or even just for a cup of coffee. In Japan, people tend to have zero tolerance for waiting in restaurants because they're so busy. Few people would go back to a place where they had to wait a long time for a meal (especially during weekdays), but everybody is resigned to long waits at the doctor's office.

Marcia said...

People are so spoiled, aren't they? No matter what we have, we want more.

I'm glad your health care is so excellent. I live in "desirable Wisconsin." :) I feel we do have wonderful care, and I'm grateful for it. We seldom wait more than 15-20 minutes, and have never been delayed in the emergency room. Once we waited an hour (for rebandaging of a wound -- no discomfort or emergency involved) and got a profuse apology. But the uninsured are certainly among us, and I can't whitewash the expense -- with the deductibles most insurance plans have, we fork out plenty.

I always bring work to appointments. The way to not resent waiting time is to be sure it's not wasted time.

Murr Brewster said...

I honestly believe that the people with the least to whine about are the most likely to whine. They have no perspective. That also explains the amount of time I spent in a postal office listening to well-employed people whine about all those LETTERS.

Mary Witzl said...

Marcia -- I'm spoiled too, but I tell myself at least I'm aware of this.

In the U.K., our taxes are high because of our 'free' medical care, but I really do believe it's worth it. Whenever we go back to the States, I'm always on tenterhooks that one of us will get ill and we'll end up paying a fortune. The issue of medical costs always worries me.

You are wise to take your work with you. When you always have something to occupy your time, you never have to grit your teeth in frustration when stuck in a line or waiting room.

Murr -- Postal workers whining about letters? You'd think they'd be more concerned if there weren't any...

It used to amuse me when San Franciscans used to gripe about the tourists, who were pretty much our bread and butter. Tourists used to get on everybody's nerves, even when they weren't doing anything more obnoxious than wearing inappropriate clothing or wanting to know where to catch the cable cars. I always wondered how the complainers felt when they themselves visited foreign cities. They didn't seem to realize that unless we choose to stay in one place all our lives, at some point we're all tourists.

Kim Ayres said...

I've had waits of hours before now, so if I'm ever going to the doctor's I always have a sudoku book in my pocket. But here in CD, I barely ever manage to get much of the puzzle done before I'm called through.

Mind you, that's been since I changed my doctor. The first one I had overruns with each patient by about 15 minutes. Accumulatively this means you have a really long wait if your appointment is later in the day