The Pharmaceutical Journal
Vol 269 No 7229 p908
21/28 December 2002

This article
Reprint
Photocopy

The English patient

I lasted precisely two days of the intended meeting at the University of Florida; just long enough to give my presentation and seminar before succumbing — dramatically and publicly — at the start of my farewell dinner before going on to the resort conference.

The pains in my nether regions, that I had dismissed as merely the consequence of eating an in-flight breakfast when my body clock said it was midnight, became acute and insistent and I passed out. My three American colleagues knew exactly what to do. Telling me not to choose the local teaching hospital because "teams of students will be watching your every symptom", they took me to the public hospital in Gainesville. Mentally noting that my medical insurance details were back in my suitcase in my hotel room, I gasped out my leading symptoms to the triage nurse sitting behind the grille in ER. The place was quiet at 7pm and I was whisked through to a trolley bed in an examination room and gave the first of many litanies to a bewildering range of hospital staff.

"Yes, I did have insurance. No I wasn't on a patient benefit scheme with my employer. No, I didn't have a preference for the physician who would treat me. Yes, I was English — glad you like the accent", all the while clutching my belly and trying to remember that loos are bathrooms (or even restrooms) in the US and my preference is for "hot tea".

Within about an hour a doctor arrived, scrupulously polite and relentlessly cheerful like all the other staff: "Over 50, ma'am? Well, here's the picture: 50/50 chance it's diverticulitis. Any history of that?" (Good grief, no. I try to eat my five portions a day, honest!)

"Here's what we'll do. You'll drink a lot of contrast stuff so we can get a good picture, then we'll X-ray, ultrasound and CAT scan to see what's going on. We'll be able to tell you for sure in about two to three hours".

Good as his word, a can of Gatorade was given to me with lurid warnings from the nurse about how bad it would taste: "Lots of people get sick; here's the alarm button if you think you will vomit". It was fine; lemon and lime Lucozade really.

After three cans, definitely fit to burst, I was wheeled off for the battery of tests and the diagnosis was confirmed. Result: an immediate iv drip of ciprofloxacin and metronidazole. Oh, and just before they admitted me at 3am, they charged $1,000 dollars on my credit card — just in case.

Readers, I survived. The two-bedded ward was nevertheless like Grand Central Station and, being an inpatient for two nights, meant I missed my conference altogether. My consolation was the kindness and support provided by my recently acquired colleague who offered me the hospitality of his family home before my return flight. I also had several days to reflect on and discuss the American health service.

It is not true that American hospitals want to see the colour of your money, or your insurance, before they will treat you. A US wide law passed several years ago requires all hospitals to give emergency care to all comers and to stabilise them before discharge.

It is true that every transaction is costed and the hospital business office was able to tell me that the total cost of my treatment by the second day was "$2,780, ma'am". It is true that some 30 million Americans fall outside the Medicare programme for the over 55s (which does not cover prescription medication), outside the safety net of Medicaid for the truly poor, and yet do not earn enough to pay for medical insurance.

The effects of this system are startling. Many of these 30 million who develop chronic diseases either beggar themselves or their families to pay for treatment or wait until their condition warrants emergency treatment before seeking help. The local paper carries many advertisements inviting members of the public to take part in clinical trials to achieve management of their condition. Advertisements in the Gainesville Sun, 2 November 2002, included:

University of Florida Center for Clinical Trials research seeking volunteers for trials into the management of osteoporosis, kidney disease and cirrhosis. Stated benefits are "the opportunity to be screened, carrying out of certain tests, several nights accommodation as an inpatient, outpatient stays or visits and free medication"

"Is diabetes raining on your life? You could qualify for regular check-ups with a trained physician. If your diabetes is uncontrolled, you could qualify for a 12 week study of investigational medication designed for type 2 diabetes" Contact type2study.com

The teaching hospital and the University of Florida compete with privately run concerns to attract clinical trial clients. The hospital takes newspaper space to announce new doctors, and their backgrounds, joining the staff. A pain care clinic is closed because it was not making enough money, thus aborting a clinical trial on pain management.

I doubt that in the National Health Service I would have had the luxury of a pneumatic, bedsore-limiting bed as standard (anyway, my UK colleagues tell me that these sometimes make patients nauseous), or a virtually private bathroom, and I might have spent many hours on a trolley in a corridor rather than in a room. However, even in America, patients get forgotten and die on trolleys in private rooms and emergency care is constantly interrupted by more urgent cases taking precedence over those who are merely rather ill. Conversely, in the UK, no one would have been pressing me for details of who precisely would be meeting my bill at a time when I was poorly equipped to provide the answers.

And my British insurers? Full marks for offering to return my telephone call to my hospital bed. Slightly fewer marks for insisting that a consent form be faxed to them to confirm with my GP that this was not a pre-existing condition before agreeing that they would indeed accept the bill for my care. Next time, I'll take a note of my GP's full name, address, postcode and telephone number as well as the photocopy of insurance documents and passport details. But it is still unlikely that I would have carried these with me for a meal at a restaurant.

And if I hadn't had a "native" with me? Or if I were in a country where the language was not English? It's enough to make you stay at home!