Death By Copay And Relief Abroad

I've been living in London for just about a year now, leaving a good job at a non-profit to come and get my master's in the UK. Like many Americans going abroad I was warned about the dangers of the NHS. And truthfully, I became a little nervous about these 'free' doctors. Would they be any good? Would I have to wait a month to see one? I've always been fortunate to have health insurance, but being an athletic though clumsy youth gave me many opportunities to see the inside of the emergency room, and I can clearly remember my mother turning to me and saying, "Do you want to guess how much your little trip to the ER cost us?"

They say that the biggest killer of Americans in England is getting hit by a car because we look the wrong way for oncoming traffic. Well, I didn't make that mistake, but I still got hit by a car five days after landing in the UK. Luckily the driver had only just started to accelerate from a stop, but I took a short and painful flight off the hood. I was left pretty banged up and hobbling. I went to my doctor's office located just three blocks from my house, and was told that if I wanted it, an ambulance would come and take me to the emergency room. I decided to wait 20 minutes for the daily clinic. Apparently some GP's here set aside two hours a day to see patients with urgent issues who did not have an appointment. Twenty-five minutes later out came the doctor, in I went, and ten minutes later I had a nice wrap for my ankle, some bandages on my scrapes, and a prescription for high strength Advil. Upon leaving I asked what my co-pay would be for the visit, and the receptionist looked at me befuddled before nicely explaining that it really was free medicine. 'Very cool,' I thought. Maybe the NHS wasn't the death-trap I had imagined?

While that might be a nice story about the NHS, the meat of my story is just beginning. I have been doing ethnographic research with officers of the Metropolitan Police Service as part of my dissertation, and spent much of the month of July in the back of a squad car racing around to calls. I saw many incidents where patients were rushed to the hospital, and many more where they were provided care on scene. All of it at no cost, and top-notch. It began to open my eyes to the problems with our paradigm of health care as a commodity.

My most striking moment came on the last night of my project. We received an emergency call about a boy hit by a car and with sirens wailing we were there in less than 30 seconds. There is something about a child screaming out hysterically in agony that is just sickening, and knowing you can't do anything to help just makes it worse. The boy had a clearly broken ankle, and other significant injuries that we would later learn included broken clavicle, broken wrist, cracked skull, and internal bleeding in his belly and brain. His mother and sister were kneeling over him, trying to keep him from thrashing about, but the boy howled in what must have been excruciating pain. Not 15 seconds later, a station wagon from the London Ambulance Service, with a medic and loaded full of gear, pulled up and immediately began to work on the boy. Moments later a full ambulance pulled up with two more medics. After seeing that it was a child with a head injury the call went out for a HEMS teams. These are the guys that normally come by helicopter, but they also have six teams in high powered BMW's patrolling around London. In less than three minutes from the call going out I could see their lights approaching our scene, and out came another medic, a full fledged ER doc, and an two med students. This boy was loaded on the ambulance and after a few minutes was on his way to a specialist head trauma emergency room just a few miles away. Traveling with him were the doctor, two medics, and a med student/resident. As the first officers on scene, we had to stay with the victim until the full extent of his injuries was determined.

For three hours we sat alongside the boy's mother in the waiting room.

We tried to talk with her about things like the weather and other BS you say to a mom whose son is behind the door that only opens for fancy medical equipment and hospital personnel covered in blood. Luckily, it soon became apparent that the boy would probably be okay in the long run. He'd have a crappy rest of the summer in some casts, and probably a week in the hospital followed by some physical therapy. In time he'd be back to being a kid again, though more mindful about running into the street. We watched them wheel her son past us on the way to a CT scan, in an induced coma, and with a ventilator tube in his mouth. She held one hand over her mouth, softly touched his face with her other, and quietly said to him, "You're gonna be okay, baby."

What struck me about the whole situation was that the boy's mom was able to focus on her son and his well-being. She never got approached to sign insurance forms, never worried about how much the hospital bill was going to be, never any of those things that get piled on top of an already horrendous situation in our country. A boy got hurt, a boy got care, and the whole process revolved around making sure he was going to be okay. The question of cost didn't come into the calculus for his care that night.

A very simple realization came to me that night: quality of health care shouldn't be defined by money, it's just the wrong paradigm. I don't know what the right solution is for our country. I don't know how Blue Dogs will vote, or what Big Pharma is going to push for. I do know that every person deserves excellent health care that is motivated only by the well-being of the individual. If we can't bring ourselves to do that, maybe it's time we amend the Hippocratic Oath to better represent pay-for-service medicine. Cheers.