Sunday, July 18, 2010

HEALTH CARE: A FOREIGN ENCOUNTER

We arrived at our vacation home on Sunday, May 16th, to celebrate the 60th birthday of my wife Cathey’s twin sisters, Connie and Liz. By Monday morning, Connie had fallen ill with a hacking cough, lung congestion making breathing difficult, and a low-grade fever. By Tuesday, it was clear that Connie needed to see a doctor.

One problem. Our vacation home is in a small village in the south of France. Connie and her husband Paul did not have travel insurance. Cathey and I had never interacted with the French healthcare system. Since I was the only member of our party who spoke more than a few words of French – and I’m by no means fluent – the task of arranging for Connie’s care fell to me.

I was concerned about my ability to communicate. I was concerned about the time that it would take to get the care that Connie needed. I was concerned about the lack of insurance. I was concerned about cost.

As it turned out, none of my concerns were valid. Here’s how it went:

TUESDAY, MAY 18th
• 11:00 AM – I walk a block to the pharmacy in the village square to ask about a doctor in the village. I’m given directions to a multi-doctor practice two blocks away. I ring the bell on the door of a large house, probably once the home of a well-to-do vigneron (wine maker) with a brass plaque by the door showing the names of three doctors. A young woman in jeans answers. Between my limited French and her limited English, we manage to make an appointment for 1:30 that afternoon.

• 1:30 PM – Connie, Paul, and I enter the waiting room. It’s lined with cheap plastic chairs and has reasonably current French magazines to leaf through. One patient is ahead of us. Within 10 minutes, the doctor – a woman of about our age dressed in whites over casual clothes – calls us into her office/examining room. It was probably the old front parlor complete with marble fireplace.

We sit in front of the doctor’s office desk and do our best to explain the symptoms. The doctor seems to understand and motions Connie to an examining table. She uses her stethoscope, she takes Connie’s blood pressure and temperature, she puts a clip on one of Connie’s fingers to test blood oxygen. We return to the desk where the doctor asks Connie about any meds that she’s taking. It’s a fairly long list – hormones, diabetes medication, a statin for Connie’s high cholesterol.

The doctor has decided that Connie has a bronchial infection and she writes three prescriptions. But there’s another problem. She doesn’t like Connie’s pulse. It seems irregular. I have taken the time to learn the French word for ‘nurse’ and, on hearing that Connie is an infermiere, the doctor asks Connie if she thinks that her pulse seems normal. Connie admits that it does not.

The doctor recommends blood work and a cardiac consult. Using both her desktop computer and an overstuffed appointment calendar book to find the necessary contact information, she calls a nursing service and arranges for a nurse to come to our house the next morning to draw blood. She then calls a cardiologist’s office in Beziers – a city of about 75,000 people less than 10 miles away – and arranges an appointment for Thursday afternoon. She hand writes a letter that we are to take to the cardiologist.

The doctor charges us the equivalent of about $25 for the visit – not the co-pay, not the negotiated insurance rate, but the full charge – and she wishes us well.

We go back to the pharmacy to have the prescription filled. We’re charged about $80 – not the co-pay, not the negotiated insurance rate, but the full charge.

WEDNESDAY, MAY 19TH
• 8:00 AM – A nurse, casually dressed, rings our doorbell. She doesn’t speak English but what’s there to say? Connie rolls up her sleeve and the nurse draws several vials. We’re charged the equivalent of $8.50 – that’s not a typo and that’s not the co-pay, not the negotiated insurance rate, but the full charge.

THURSDAY, MAY 20TH
• 3:00 PM – We all climb in our rental car and head for Beziers. After getting lost a time or two, we find the cardiologist’s office on a side street off a busy avenue in the northwestern quarter of the city. It’s more like a typical doctor’s office, in a low cinder block building with office suites for several practices. We announce ourselves and are directed to a waiting room with comfortable chairs, more French magazines, and contemporary art on the walls. After a wait of about 15 minutes, the doctor calls Connie and I into his office, more like a den than an office, with a big wooden desk and shelves full of books.

The cardiologist doesn’t speak very much English but we manage to convey the symptoms Connie is experiencing. We hand over her list of meds. The doctor dictates for a minute into a small cassette recorder, then leads us to an examination room. He listens to Connie’s lungs and heart. He takes her blood pressure. He performs an EKG and an ultrasound of her heart. (This requires Connie to disrobe completely above the waist. The doctor asks if I’m Connie’s husband. When he realizes that I’m not, he makes certain that I turn away.) We return to the office. He dictates some more.

The doctor shows Connie the results of her labs. There’s a potassium deficiency which could very well explain the arrhythmia. He begins explaining the complications that can arise from diabetes. In frustration over our language difficulties he pulls out a little laminated folder with pictures. I explain that Connie is a nurse and he makes clear that she should therefore know the importance of exercise and diet.

The cardiologist dictates some more, prescribes a potassium supplement, and hand writes a letter back to the GP in the village describing what’s been done. We shake hands and he wishes us well.

The cardiologist charges us the equivalent of about $150 for the visit – not the co-pay, not the negotiated insurance rate, but the full charge.

• The pharmacy charges $10 for the potassium supplement – not the co-pay, not the negotiated insurance rate, but the full charge.

SATURDAY, MAY 22nd

Connie is much better. She joins fully in our second week of sightseeing, wine drinking, and cheese eating. Within 48 hours she’d seen two doctors – a GP and a specialist, had a home visit from a nurse, had lab work done (We got the bill in the mail for the lab work after a few days. $70 – not the co-pay, not the negotiated insurance rate, but the full charge.), and had an EKG and an ultrasound. She had four prescriptions filled.

Total cost? Under $350 – not co-pays, not the negotiated insurance rates, but the full charges.

Ask yourself the following questions:

1. In the USA, if you didn’t speak the language very well, if you didn’t have a primary care physician, and you had no insurance, how long would it have taken you to be seen by all of the professionals that Connie saw in France? Would you have been shunted off to an emergency room instead?

2. In the USA, how much would all of the treatment that Connie received have cost at ‘retail’?

3. In the USA, why do we continue to demonize ‘socialized medicine’ and why are we willing to pay more per capita for healthcare than any other industrialized nation?

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