Comparative medical bureaucracies

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Of all the phrases the divide British and American English, the one I dread hearing is leave it with me. It’s not a phrase I ever heard in the U.S., and now that I live in Britain I know life is about to spin out of my control when someone says it.

And yes, I do know life’s always out of our control, but we all like to believe, don’t we? We live for the comfort of that illusion. Even when we know we’re full of shit. Maybe especially when we know.

Or some of us like to believe. I like to believe.

Irrelevant photo: The causeway to St. Michael's Mount, emerging as the tide drops. There's a castle out there, hidden in the fog.

Irrelevant photo: The causeway to St. Michael’s Mount, emerging as the tide drops. There’s a castle out there, hidden in the fog.

Suppose I need a referral from my GP to a specialist and I was supposed to be given an appointment by Wednesday and here it is the Tuesday after that Wednesday and I still don’t have the letter telling me when the appointment is. So I call to ask what happened. I’ve worked out an approach for this kind of situation. I’m polite and I’m relentless. I don’t demand, I don’t insult, and I don’t go away. This is easier to pull off when I’m advocating for someone else, but I can manage it for myself if I have to.

The receptionist says, “Leave it with me.”

Which means one of two things: 1. I will fix this so fast that whoever screwed it up will be dizzy for a week, or 2. I will make a note of this, bury it under a stack of paper, and forget you ever called, because your referral’s still a bunch of electronic blips in my computer but I don’t remember which file it’s in, or which computer, or what electronic means. Furthermore, I have worse problems than you. Don’t call back.

And I’m never sure which. Except for the don’t call back bit. I’m sure what that means.

I’ve learned to ask, “When will I hear from you?” so at least we’ve agreed on a date after which I’m free to make a pest of myself again, but until then I’m helpless. All my polite don’t-go-awayedness? It’s paralyzed by the leave-it-with-me beam of bureaucracy.

In the abstract, I could probably say, “No, sorry, I can’t leave it with you. Gimme my problem back,” but you know that bureaucracy beam? It’s like kryptonite. It keeps me from forming those words.

I did dodge the beam once, when a neighbor was having a medical crisis and D., who’s been a nurse, armed me with a magic phrase: That’s not acceptable. I listened to myself say it and wondered who I’d turned into, but in fact waiting wasn’t acceptable—it was a crisis—and since the phrase was magic it worked.

But you have to be careful with magic phrases. You can’t just spew that’s not acceptable in all directions and under less pressing conditions.

The leave-it-with-me problem stems, I think, from the British medical system’s paternalistic streak. The U.S. system is also paternalistic, but in a different way and—oh, you know how it is: When you’re not used to something, you notice it. The things you’re used to? They’re invisible. And the way they handle medical appointments here? I notice. If you need one, it will all be done for you and you’ll be told when to appear.

What if you can’t make it? You know, if you have to be in court that day or they’ll issue a bench warrant or you have some similar whim you might want to follow? At that point you get to step in and change the date or the time, but you have to wait to be given the wrong date and time before you can step in. And unless your condition’s a crisis, it’ll come by letter.

As far as I can figure out, this is true of both the National Health Service and private-sector medicine. Because that’s how it’s always been done and why change now just because the telephone’s been invented? And that other, even more modern thing, the inter-whateverit’scalled.

In the U.S., I can remember two systems for making specialist appointments. In one, I was given the name of a doctor and clinic (or a list of several) to call and I made my own appointment. In another, I stood at a desk while someone who worked for the clinic that was referring me made the appointment and could talk with me about whether I expected to be under arrest or in court at any given date and time.

In other ways, the NHS is more egalitarian than the U.S. medical system. I just read a nurse’s comment that “everyone is equal in the NHS; I find that amazing. In India, you can’t challenge a doctor, even if he is wrong. Here, a nurse can tell them straight away.” Unless things have changed since I last heard (and it’s not a topic I keep up on), challenges from nurses aren’t welcome in the U.S. yet.

But patients don’t seem to have claimed their power from the system, even if nurses have. So listen up, bureaucracy: I’m registering my complaint. Can I leave it with you?

63 thoughts on “Comparative medical bureaucracies”

  1. Leave it with me falls into the set of British platitudes which make people believe things are going to be done forthwith and allows them to go away and forget about it as does the other person and nothing gets done.

    I hate the appointment system, sometimes the wait is so long that there is no point in taking up the appointment as you have either died or got better!
    you forgot that not only do appointments arrive by letter, but sometimes letters arrive (after a month or so at least) to tell you that you have been put on the waiting list for an appointment and you will get another letter in 3 months time telling you when you can have one!

    I think it is a polite British way of telling people to suck it up and walk off the pain!

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        • Actually, for all the problems, it does work. People get treated. People get better. People don’t go broke (or out of their minds) trying to figure out how they’re going to pay for their treatment. I wouldn’t argue with some improvements. I would–and do–argue with what this ^%$£*&(*! government’s doing to it.

          Oops. I got all serious on you there. Sorry.

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          • No need to apologise! It does work, and everyone in the country can be safe in the knowledge that in an emergency they don’t have to decide between eating and getting medical treatment!
            and if it isn’t an emergency, the same is true, it just may take longer!
            People do complain about it, but it is the best in the world (I think…I don’t actually have stats to back that up or experience of many others…so I may be biased)

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  2. Oh, I don’t really mind that phrase. Actually I rather like it-to me the person is saying:’ I now assume full responsibility for your problem/issue. Don’t fret now.’ But that’s just my take on it…

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  4. Sorry, I don’t want it.
    We deal with the American system almost every week. I don’t want to learn to navigate another one.
    I think that some us (that means me) idealize the fully socialized heath care system in other countries. The reality is that they all have their flukes and flaws.

    Liked by 1 person

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    • Everything does. The core advantage over here, though, is that everyone is covered. No one says, “Don’t call an ambulance, I can’t afford it,” or anything like that. Another advantage has been that because it’s been (until the Conservatives started fucking it up) a unified system, so problems could be a national discussion. On the down side, that makes the system look bad, because problems are public. On the up side, they can be addressed.

      All told, I prefer the problems this system has.

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  5. I found this post very interesting. I am in Australia and when we get referrals from our GP to a specialist we ring and make our own appointments, at a time to suit us. If you need surgery (from a public hospital) it is a different matter though.

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  6. I love the way you handle these topics. I would have a hard time masking my frustration as I wrote this. In the US, I’ve found that the first item of concern is your status. Are you a patient? Have you ever been a patient? Were you referred by a partner? The second is insurance. Do you have insurance? Who is your provider? Last, and seemingly least by far is your health. The most ridiculous encounter was that of a friend who was told by her primary care doctor that she had a life-threatening condition and needed to see a specialist to arrange for surgery. The specialist couldn’t see her for 6-8 weeks. That’s when your magic phrase would have been appropriate.

    Liked by 1 person

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    • It would have been appropriate, but so would a loud scream. Or possibly biting someone.

      I’ve been here long enough that I’ve almost forgotten that the first issue in the U.S. is money: insurance and everything connected with it. How could I not have mentioned that?

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  9. A thought provoking post Ellen and one that I’ve reblogged on my blog.
    Me personally? If anyone says those four little magic words to me I don’t trust them. I really want to, but we all know that they are probably so overworked, underpaid and stressed out that they’re trying to convince themselves that they really can deal with your problem…and the world’s.
    We’re too polite. Maybe we should tell it how it really is. You’ve no chance until we’re all reading from the same page. That is never going to happen. Unless you happen to have a magic wand. :)

    Liked by 1 person

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  10. Very odd that they don’t have “choose and book” in Cornwall. Your GP has no control over the hospital appointments system. It works like this: GP decides you need to see a particular specialist, sets up a referral on computer, gets a code, you get this plus password, and then you go on line or telephone to choose the hospital and time from the appointments available. If there are no appointments available, it is up to the hospital to find one for you. You decide whether to accept it or not.
    This is for routine stuff. If your doc thinks you might have cancer, you get a two week wait appointment from the hospital. Less choice for you, but as soon as they can fit you in.
    Emergencies go directly to hospital, without passing GO, of course.

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  12. I’ve been known to pitch serious fits when it came to mistreatment of my seriously ill hubby. Can’t seem to be quite as effective when it comes to my own self. Likely ’cause I’m feeling to sick to give it my all.

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    • Could be, but I know something kicks in when I need to advocate for someone else that just doesn’t when it’s for myself. Maybe because it’s not complicated by any self-effacing, oh-no-you-first stuff.

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  13. I learned a long time ago that sometimes I have to be a pain-in-the-ass to get things handled. I used to accept “leave it to me” or “I’ll take care of it” thinking that the problem has now been – or will be soon – taken care of only to find myself spending even more time following up and, often, starting all over with someone else. I hate to be pushy, but sometimes “that is not acceptable” just has to be said. It’s often a fine line that must be tread between being nice (always preferable, and often it gets the wished for results) and being firm. Although, “leave it with me” spoken with a charming British accent probably would melt me into a puddle of gratitude and hopefulness.

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  14. When I first struck out as an independent adult at 17, I experienced such a concatenation of beauracratic foul ups that I learned very early on to be assertive, demanding and be clear about what I would not tolerate and what scow rations I had for setting the problem right. It’s how I’ve lived my life ever since. I sometimes make my husband judder with my bolshiness, as he shrinks back and tries to pretend he’s not with me, but I never take that approach until it’s justified. I do wait for people to evidence their incompetence before I tackle it.

    I have been a patient in many NHS facilities and institutions and none were run like a well oiled machine it must be said. Even when my treatment was spot on, something would be wrong with the admin or vice versa. Perhaps it’s that healthcare is such a behemoth that trying to wrangle each and every element of it is some sort of Sisyphean challenge.

    The last GPs surgery I was registered at in Scotland provided a high standard of care and excellent service except for its appointment system. They had a same day appointment allocation yet never seemed to have a vacant slot even when I called at opening hours. What that meant was that everyone learned to start phoning up to an hour before opening and it was a lottery as to whether you got through first.

    Our family doctor here in the U.S. has a system whereby you can book appointments up to three days in advance. Still when I call I have more often than not found that no appointment is available for the day I want. I’ve also had to wait 14 months for a specialist pediatric appointment for one of my kids. I resent the inefficiency more here, of course, because we pay through the nose for healthcare that is – so far as I’ve experienced it at least – no better than the NHS. At least my frustrations were free in Britain.

    As for “Leave it with me”, my experience tells me that’s usually code for “I might get around to it if I’m really bored but otherwise it’s going to moulder in my inbox for an eternity or until you darken my doorstop again”.

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  16. The self-advocacy thing is so hard when a person is ill, but “there’s nothing for it” as folks on your side of the Pond might say. Especially in the US regarding mental health, insurance drug coverage, and anything relating to Medicare and Medicaid. Even when I have all my paperwork in order, give the pharmacist written (by me), step-by-step instructions, they still do whatever they want instead of what the insurance company wants. I have to follow up on every detail and have stood at the pharmacy counter, immoveable, until whosits or whatsits gets done. I don’t get mad. I just don’t go away.

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  17. My wife: “You sound horrible, you should make an appointment at the clinic.”

    My wife’s niece: “I pay $500 a month for insurance, how can I afford the copay?”

    See, that’s the superiority of the American system. They are quick to snatch that copay.

    Liked by 1 person

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    • Yes, they do keep their eyes on the primary purpose: making money. Health? That’s a byproduct. If you’re lucky. It makes me crazy when I hear people (for which read politicians) over here talk about the American system as more efficient.

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  18. Pingback: Updates on tea and medical bureaucracy | Notes from the U.K.

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