March
2006
The other side
So, yesterday saw me posting about the joys of working in healthcare here. Today let’s turn the table and talk about being a patient.
Theoretically healthcare is free in Ro, payed for by substracting a percentage of each working citizen’s salary. Practically most of the money doesn’t get where it should but dissapears misteriously into the black hole that is the State Healthcare Insurrance . The rest is used mainly to pay salaries (our hospital for example has too few docs, nurses, cleaning ladies and paramedical professionists but instead a huge birocratic apparatus, a few kitchens, cleaners, pharmacies, a small army of plumbers, electricians, carpenters, pig farm workers, drivers, informaticians and elevator operators. But no security - I presume they want us to taste the adrenaline. Heh.) Almost no renovation is made except for the case when financing comes from outer sources. Almost no new equipment is being purchased, except for the case of a mutually beneficial agreement between some big gun in the management and a firm, this leading usually to insanely inflated prices for the equipment and a sudden financial situation improvement for the aforementioned management member.
Bribing is implicit, occurs on all levels and is taylored for each member of the staff that you, as a patient, get in contact with. You give a chocolate to the cleaning lady to get a new nightgown, to get your sheets changed, to have your kid’s or your sick grandmother’s butt wiped. You give a coffee pack or a box of chocolates to the nurse so she’ll remember to give you the injection, have your admittance papers done in time or change your IV drip when it’s empty. The docs get usually money (in the proverbial envelope) or fancy liquor bottles for checking up on you, admitting you in the hospital, granting you sick leave days, delivering your baby, performing surgery on you or generally giving a damn. As a psychologist I’m offered money, chocolate, coffee, tobacco, cheese, eggs, milk, flower bouquets, flowers in pots and kitschy decorative objects. I refuse the envelope, but I don’t expect you to believe me . After all, I’m the exception, not the norm.
So as a patient you’re usually coming to the hospital from your family doc. You’re confused if you’re coming for the first time. You find some nurses and ask for information. Then a few phases will occurl:
phase a) Nurses ignore you while continuing their chatting/coffee drinking/ cigarette smoking
phase b) They notice after a while that you’re still there, give you the annoyed look (y’all romanians know what I’m talking about) and look at the papers
phase c version1) They tell you to go elsewhere even if you came to the right place (the hot potato technique or as it is known over here patient ping-pong)
phase c version 2)They tell you you came to the right place but you don’t have the right papers and need to go back to your family doc/ employer/etc and get them
phase c version 3) They yell at you for coming too early/too late to be consulted
phase c version 4) They tell you you’re at the right place, at the right time, with the right papers so WAIT.
phase d) after you finally get to version 4 of the previous phase, you usually spend at least an hour (if you’re lucky) waiting on the corridor in front of the doc’s room. While doing that you chat, socialize, discuss politics, economics and your illness with the other waiting patients if you feel like it. If not, you admire the variety of the cracks in the walls and read carefully the ads for medication displayed on the corridor. You walk a lot. You tend to feel sicker than when you got to the hospital.
phase e) you get to see the doc. This phase usually takes about 1/20 of the time needed for the other phases.
I have to admit the Romanian experience sounds far worse than the American medical culture (pun intended).
We’ve no direct bribery. It’s a matter of billing. If you have insurance, you pay a small fee upon arriving at the doctor’s and the insurance company pays the outrageous invoice. Then you pay ridiculous amounts of money for your monthly insurance. Of course, this is generally hidden from you because the employer pays the bill instead of giving you a payraise… which is why you make next to nothing and can barely afford to pay your credit cards the monthly minimum. Constantly treading water with your nose just above debt level, all because you don’t want to know what it costs. (”Can’t someone else pay for it?!”)
If you have no insurance, you’re fucked. Unless you’re one of the few who happens to be financially responsible and has a savings account, but that doesn’t occur often in America. (If it’s a true emergency, in which case the hospitals must take care of you, by law.)
Either way, the doctor will make enough money to buy himself that new BMW sedan, the Mercedes SUV his wife wants, the Toyota sypder his blonde college-age secret lover wants, all the toys his children want, a few vacations to luxurious destinations, that new 3-story, 8-bedroom home his wife wants, the cozy 3-bedroom condo his other secret blonde college age lover wants, and (at the annual holiday party) all the booze his staff can drink!
How can he do it?
Well, it’s not just the unbelievably insane prices he charges. No, no. We’re much more sophisticated in our ability to disrespect customers and maximize our revenue efficiency.
Ever so courteous during the customer acquisition phase, the medical firm will happily offer you a precise appointment for 10:05a or 4:20p on the dot. How’s that for the ultimate in convenience?
Upon arrival, you enter the quaint and pleasant waiting area. Staff hides behind a sliding door that no one can see through. Why? They are not working. On the phone talking to the boyfriend and touching themselves under the counter, or playing solitaire on the computer, or sometimes you can hear a gaggle of them telling jokes about some naked patient in the other room.
So, you knock on the sliding windows and it opens. You see the displeased face of some $5/hour idiot secretary who’s pissed off that you’ve ruined her good time.
She tells you to have a seat and that someone will be with you soon. Then, proceeds to give you no less than 17 legal-sized, double-sized, small-print questionaires to fill out… you know, for “insurance liability purposes.”
You don’t even notice the 2.5 hours going by as you eagerly answer all the inane questions on the form. Have you had bone cancer? Did your mother have a heart attack? Were any of your 3rd great-great-grandcousins ever considered to be insane or otherwise unusual by anyone at all, to the best of your knowledge? Did you urinate this morning? Are you feeling grumpy right now? Do you think Rapid will win the UEFA? Would you be concerned about world hunger if you lived in Africa? What is the average velocity of an unladen swallow?
Finally, you finish forms and hand them in… again, interrupting the lazy girl’s otherwise perfectly good time, you jerk.
Now, you get to sit and wait, fully conscious of the time while security cameras track your every move and you wonder who is watching. You catch at least 3 different contagious diseases from the very ill people around you. But, the good news is they’ve given you all manner of magazines to read. Oh, joy! You can finally read the April 2004 issue of people magazine and catch up on what Brad & Jennifer were planning to name their puppy. Or you could read the latest issue of Highlights and test your skill in being able to solve puzzles intended for 10 year olds. Otherwise, there is always the fancy car magazines full of automobile reviews for toys only the doctor could afford.
Finally, the other 17 people they scheduled for your 10:05 or 4:20 time slot are slowly being served one by one and you, too, get called in behind the secret Inner Door.
An overly chatty, but unlistening, nursing staff member (who is always, ALWAYS dangerously unhealthy) leads you down a confusing labyrinth of corridors to make sure you cannot escape, until arriving at a very cold and uncomfortable room. You are summarilly told to strip. Oh, only here for an eye or ear exam? Well, strip anyway. Get naked and put on this paper robe that reveals all your natural glory.
You sit again. This time you get to count all the cotton balls, tongue depressors, band aids, and rubber gloves left in the industrial sized box. Amaze yourself with the variety of his needle collection. Thrill the time away by peeking into the Hazardous Materials wastebasket.
A different nurse comes in and asks you standard questions. Are you ill? What’s wrong? Can you stand one one leg? Do you speak English?
Okay, the doctor will be here soon because that last nurse is always like a hunting dog sniffing the ground just before the master arrives.
Within 10 to 15 minutes, he does arrive! Carrying himself as though he were the distinguished president of some small foreign country, he parades around importantly. His first concern is to skim over all the documentation you and others have been filling out regarding the splinter in your thumb, while giving the appropriate deep breaths and intellectual hmmmmphs. He peers up and looks at you from an angle where his eyes are not looking through the reading glasses… so, how are you feeling, he asks mockingly?
Without listening, he tells you to stand up and then promptly gropes your testicles or breasts with his freezing cold hands depending on whether you are male or female or if his eyesight is bad. After exciting himself with his raw power over your physical form, he asks a variety of questions that actually sound relevant, for once. Then he assures you everyting will be okay and exits.
In comes the same nurse from before who explains to you what is wrong and how it will be fixed. A number of nurses come and go doing little tasks related to your situation. And basically the entire process heretofore described, begins to unravel in reverse.
You came on a Tuesday, you leave on a Thursday. You pay $1,800 for a $200 solution. You see 17 nurses and 4 minutes with a qualified doctor. But you had fun, right?