David goes to the hospital: More Proof American Health Care Is Broken

Going to a hospital in a foreign country has to be one of the top 10 most frightening experiences I can imagine while traveling (what’s that snake for? Doc? DOC?!?!).  That’s why you can understand my anxiety in going to seek medical care here in Korea not once, but twice in the last week.  Luckily, my fears proved not just to be unfounded, but opened my eyes in a lot of ways to the kind of treatment we should expect back in America.

I’m not alone, I suspect, in my distrust of physicians when it comes to common illnesses.  When I was in my teens, my family sought out a half-dozen practitioners of different specialties to figure out what was causing my chronic, persistent cough.  A few said I had a lung disease, one diagnosed me with asthma, it was even speculated that I had tuberculosis or the whooping cough! (perhaps cause for a second opinion)  It wasn’t until a pediatrician named Dr. McCormick (Mr. McCormick’s wife) identified pollen and dust, not a pernicious virus, as the culprit that I found relief from the often-painful coughing spasms that would wake me up in the middle of the night.  

Now obviously, medicine is an art, and not an exact science.  I don’t really blame doctors for getting it wrong, even though it should have been obvious to all of us that the spring phenomenon of every car looking like it just received a yellow paint job in Carrollton was a sign that maybe allergies were the cause for my malady.  The issue is that their misdiagnosis came with a heavy cost; even though my parents had state insurance, the co-payments and the time it takes to find appointments were debilitating to say the least.  And that was back in 1998.  

Well, my first run-in with the Korean version of quackery was in Jeju.  I developed indigestion and started getting hot flashes and a nasty cough, pretty much out of nowhere on the last day of the trip.  Virus-time baby.  Jin insisted that I stop in a hospital, a solution that seemed a bit drastic for symptoms that in college, I would normally just suffer through and instead drink orange juice (maybe take some DayQuil if I had the cash).  I wasn’t dying, it was going to go away by itself in a few days.  

But by chance we passed a local, government-run hospital, and Eunjin assured me that it was going to be ok.  She’d translate for me after all, and she’s lived 26 years attending these kinds of practices.  Clearly, nothing terrible was going to happen.

I walk into the office, head swimming, and take off my shoes (oh yeah, you have to do that basically everywhere).  I sit down and try to concentrate on what Eunjin and the lady doctor were saying.  She asks for my national ID number.  I give it to her but, oop, not registering on her computer!  Great.

No problem, Eunjin says, I’ll just put it on my insurance.  Are you kidding me?  I’m incredulous at this point, both that they’d allow my care on someone else’s insurance plan, but also that she would eat the cost and drive up her own premium.  Little did I know that the favor amounted to less than buying me a Coke at a convenience store.

After asking for my symptoms, (목 앞아요!  머리 앞아요! or - My neck hurts!  My head hurts! I’ve got the expressive ability of a two year old.  And yeah, here throat, neck same difference.) she goes off and starts collecting pills and whatnot while I sit there looking/feeling miserable.

She comes back and Jin starts explaining directions that I honestly can’t even focus on.  Luckily, in Korea instead of giving you multiple pill bottles with different instructions and different purposes, they instead give you cocktails (similar to what you’d find at a nursing home) that ensure the proper dose each time it’s time for you to take the medicine.  This is done to ensure you don’t accidentally take more than one dose of the same bottle and prevents the need to memorize instructions, as well as to make it easy to carry doses in your pocket.  So she gives me about 12 packets of these things, totalling over 80 pills to treat my fever, my stomach, my cough, and one to relieve the side effects.  

Then she starts calculating the price and I brace myself.  Damn, I really should have just waited this out, I’m going to spend so much of my vacation fund on this.

900 won, she says.  

900 won?  You mean… 90 cents?  

Yeah, 900 won.

Oh. My. God.

After I returned from Jeju-do, I woke up the following Wednesday feeling like absolute garbage.  I had developed a deep, nasty miner’s cough (Who’s winning the match, pop?).  I’ll let you imagine the details.  Luckily, the symptoms the other physician treated had gone away, but now it was just all in my throat and chest.  I thought again that it would just go away, but I woke up the next morning with even worse conditions.  Thankfully, my classes were all cancelled for the day so I was able to look forward to rest… but what about the following Friday or Saturday?  I needed to act to nip this in the bud.

Again at the prodding of my girlfriend, I went to the local clinic, one specializing in Ear, Nose, and Throat medicine.  This time, however, I was on my own with no translator.  

So I walk in to the stunningly nice lobby of the clinic and walk up to the secretaries.  My listening is still pretty poor in Korean so I had trouble understanding what they wanted me to do, until I realized they just wanted me to fill out a form they printed out in English for me.  After filling out the quarter-sheet of paper with literally 5 entries (name, address, ID number, insurance number, whether you were there for ear, nose, or throat) they asked me to wait for 20 minutes.  20 minutes with no appointment?  Seriously?  Even at Emory’s student clinic I expected 90 minute to 2 hour waits on a walk-in.  

In less time than it took to read 3 pages in the book I brought with me, I was called into the doctor’s office as I was frantically looking up the necessary words on the Engilsh-Korean dictionary on my cellphone.

“So, David, looks like you have a problem with your nose and throat… would you mind describing your symptoms?”  the doctor inquired in perfect, accent-less English.  

I was a little more than surprised for two reasons: First, I was immediately treated by the doctor, not the nurse.  He was actually sitting in there waiting on me. No weight/blood pressure/height measurements (its a specialized clinic, why would those things matter anyway if I already kind of know what’s wrong with me?), no impatient questions from the nurse with answers that I’d have to just later repeat to the doctor.  Immediate care from a Ph.d in less than 20 minutes.  Amazing.

Secondly, he spoke perfect, midwestern English with no trouble navigating through technical language.  This probably shouldn’t have been surprising, as many Koreans do post-graduate studies in the US (more than from any other country, even China with 50 times the population).  I searched for the degree on the wall: UCLA Medical School.  Damn.

The doctor was efficient and sympathetic.  He was also competent.  ”Hey I’m sorry I have to do this, but I’m going to prescribe you some antibiotics.  I know, I know you don’t want to build up a resistance the the drug, and they aren’t very convenient.  But you have an intermediate stage bronchitis, and I don’t want it to spread deeper in your lungs where it might become a chronic condition.  I know this because you have a phlegmy cough, your tonsils are swollen, and the symptoms you’ve described match perfectly with the virus people have been coming in here with over the last 3 weeks.  All those patients end up with bronchitis.  So, please avoid liquor and smoky environments.  And drink lots of water!  Ok, the nurse is going to take you out, just come back on Tuesday if the symptoms persist.  Feel better.”

Probably the most persuasive case that’s been made to me on any subject, it was almost like he was completing a geometric proof or something.  There was nothing for me to protest, no reason to doubt his judgement.  Basically, I felt cared for.

After the nurse took me to a very pleasant humidifier room that loosened up some of the goop in me, I headed back to the receptionist.  They handed me a bill and a prescription list (printed out, not in handwriting) for the pharmacist downstairs.  The bill was 4,200 won.  $4.20.

The pharmacy was a similarly pleasant experience.  They did the pills in the exact way as the doctor from Jeju, separated by dose, repeating the instructions the doctor gave me about eating, no drinking and how often to take them.  They also gave me what looked like a Gatorade bottle full of cough suppressant syrup that would probably take me a year to get through (new product idea: Green Mountain Phlegm).  Total cost of antibiotics plus cough suppressant: $6.60.  Where the hell am I?

So to recap, I went to the hospital and visited not nurses, but doctors twice, and received in total a liter of cough syrup and over 160 pills.  Grand total in the United States (before deductible is met, or if you don’t have insurance): $350.  Easily.  Grand total in Korea, even for a foreigner: $11.70.

Am I saying that America should follow Korea’s model?  Not necessarily, this is a country 1/6 the population of the US and smaller than Indiana.  The patent laws are also incredibly loose here, meaning that generic drugs come to market quicker (many times unethically exploiting the research and development of American firms existing copyrights and patents, as the Korean pharmaceutical industry is far from impressive).  Major surgeries also tend to have longer waiting lines and Korea faces a growing problem of over-specialization, meaning that there is a shortage of general practitioners and emergency room doctors.

However, my experience has opened my eyes in that the American health care system really does encourage people to be sick and falls on its face in terms of preventative care.  Sure, my bronchitis could have gone away on its own… but what if it developed into a more serious condition?  What if in my weakness I became more prone to catching a contagious disease, or pneumonia if I got caught in the rain?  Let alone the productivity costs to my employer if I needed to start taking days off of work, or got my students sick.  

Add to that the fact that I was treated with respect and compassion through every step of the process, my care was immediate in one place and took only 20 minutes in a crowded waiting room, and it has become clear to me that something more fundamental than whether employer mandates (Democratic plan) or the market (McCain’s plan) provide the care needs serious revision. American health care, as everyone knows, is too expensive and too much of a hassle.  That’s probably why when a Korean co-worker just casually says, “yeah, I went to the hospital today,” we Americans totally flip and probably even scare her with condolences and expressions of over-bearing concern.

Maybe its the Korean co-worker that should be concerned for us when we go back to the United States.

~ by dogles on May 18, 2008.