An American doctor experiences an NHS emergency room

I actually have directly relevant experience to the question of "What happens if you get something in your eye in the US and need to see a doctor urgently?" Don't read the following if you're squeamish.

About a year and a half ago, I dropped my iPad while on a flight from Japan to the US. The screen cracked in the top corner. I tentatively touched the screen, to see if the crack was dangerous. I did not cut my finger, but did succeed in transferring a very small piece of glass to my finger.

People touch their eyes frequently, often unconsciously.

Six hours later, after attempting self-irrigation on the plane and at the airport, I was at a hospital in Chicago seeing an eye doctor. Time from arrival at proper floor to being taken to room: three minutes ("glass in eye" cuts down on paperwork quite a bit). Time to arrival of doctor: approximately four minutes after that.

They successfully treated me for, possible misquote, "non-traumatic introduction of a foreign body to the eye." (The attending physician's first words, after reading the chart, were "How in God's name does an iPad screen end up in your eye?")

Treatment was approximately 15 minutes of a resident's time and 5 minutes of the attending physician's time plus one cotton swap and some iodine.

Total cost: approximately $300, plus twenty minutes of dealing with the billing clerk (after approximately 30 minutes of waiting for the billing clerk to be ready).

Most of the time with the billing clerk was a result of the clerk getting the run-around from a Japanese commercial travel insurance company. I customarily travel with private insurance which, among other things, covers me for medical emergencies while traveling. (Normally I'm covered by Japanese national insurance, which doesn't normally cover treatment of Americans in America for all the obvious reasons.) The insurance company denied reimbursement for elective medical treatment. Direct quote: You could have elected to leave it in your eye.

As a Canadian, this doesn't surprise too much: People complain about wait times all the time, but the only wait times I've ever seen are for relatively stable situations that do not put the person at increased risk, e.g., corrective surgeries for non-threatening conditions, etc. (We can - and should - debate whether surgeries to correct intense chronic pain should be delayed as much as they often are, but current medico-political thinking appears to be that pain ain't so bad, contrary to current psychological thinking).

I've had a couple of exposures to emergency rooms and clinics over the last few years. The most telling was when I sliced open the back of my hand with an industrial fan. We cleaned and bandaged it, then applied ice, and I sat until the pain subsided and felt good enough to go the nearest clinic.

By the time I arrived, the pain and nausea had returned, but no biggie. I presented my healthcard and described the situation, which caused the three people behind the counter to pause and eye me as one asked "But you didn't break the skin, right?"

I did not get a chance to complete my reply, which started with "Yes, of course...". "Drop your card, come with me now".

The waiting room was more than half full, but I was priority number 1 for the next 15 minutes. A nurse carefully, delicately removed the dressing, then used a thin metal instrument to ever so carefully widen the cut and examine the tissue underneath. When satisfied, she sent me back to the waiting room where I sat for an hour and half.

I learned the full story when I returned for an x-ray the next day (I hurt myself on a Sunday, the basement x-ray lab was closed): Had I severed - or even cut - any of the tendons leading to my fingers, I would have rushed to the hospital to save my hand before the tendons shrank and dried into uselessness.

I didn't mind the 1.5 hour wait on the Sunday, or the combined 1.5 hours on the Monday, because when it came to what really mattered, there was no wait at all.

They only took my healthcard once the initial careful inspection was over. Billing and bean counting were irrelevant.

Note: I expect that billing for treatment of visiting foreign nationals will vary widely by province (anyone in the know care to chime in?), but that the overall triage process will be similar.

Well, he got into one of the better hospitals by the looks of it, I am sure there are many. I'm surprised he was not billed, from what I read on wall posters in hospitals non-residents (or non-EU?) are charged for medical services.

Unfortunately had my share of landings in E&A and I was less than impressed. Generally bad/old looking buildings and rooms, not the most skilled staff - some of them were struggling to speak English, long waiting times (my record is 5h).

On the other hand many of the people working in the NHS are literally life saving heroes, so they deserve our respect. Any country on this planet that does not have a similar system can't call itself civilised. Luckily most of Europe has this in some form or another.

This is not to say that things can't be improved.

NHS could probably run 2 times better on half the money it currently spends; I think efficiency is FAR from being their strong point. At this size it takes a special kind of management to do stuff without huge waste - perhaps Toyota can lend a hand here.[1] :-)

[1] - http://www.businessweek.com/articles/2013-09-26/work-efficie... etc

> It makes you wonder exactly what frightens Americans about the NHS?

I'm less frightened of the NHS than of a hypothetical American version of the NHS, which would be run by the US government and have (mostly) Americans using it.

I've seen posters up in the local A&E that say something like "If you're a foreigner please be aware that we'll send you an invoice". And there's certainly been statements recently from politicians talking about doing this for the dreaded "immigrants".

I suspect that the total income from this would be tiny though, and perhaps not even enough to justify the administration costs. And my impression from staff at NHS hospitals is that they're just interested in helping you and really don't care if you didn't pay.

The NHS quality is dependent on where you are in the UK. For example my 92 year old grandmother cannot make an appointment in advance to see her GP (general practioner). Instead she has to call the practice from 8:30am to get put on a list for that day. If she is lucky enough to get through on the phone she then has to be lucky enough to have been one of the first patients to get through (it is normally engaged due to high demand). Once she is on the list she has to go down to the practice and wait. That wait could be up to 3 hours. She is blind and deaf.

I live in Germany on the other hand and I am privately insured. I can get to see a doctor easily. However my health insurance has a strange caveat in that I must see and be referred by my GP if I have to see a specialist doctor. My health insurance recently refused to pay for a visit that I made to the ER for a broken arm which was caused whilst playing football at 8pm (long after my GP had hone home). I was expected to wait until the next day in agony to complete their beaucratic hoop jumping.

That being said I like the UK system because it is free (excluding taxes), whilst in general the German quality of service is exemplary (although non private patients have a much poorer QoS). If I was seriously I'll with cancer or something that requires a expidited process between diagnosis and operation then I'd chose Germany every time.

The reason they didn't bill is that it would cost far more to set up a billing system than the revenue it would generate.

Biggest problem I see with the NHS is their major issue of dealing with randomness. Wait times are totally dependent on who and how many people walk through the door at any given moment. However managers have to post staff rosters 6 weeks in advance. The cost of calling in staff for extra cover is likely to double.

As a manager what do you do?

Most doctors in the UK would be offended if you asked them how much do you have to pay while you are in a hospital. Some even would take it as you offering them some kind of a bribe.