Thread by @thisisnotariot

I’ve recently had to use my adopted country’s private healthcare system, and it is *not* like the NHS back home. It’s so weird I feel like it needs a thread. So...

Public vs Private healthcare: The small but surprisingly important differences that nobody ever seems to mention.

1/ First things first: the big differences, like having to actually get money out to pay for healthcare, and wrangling with your insurance company, etc etc, get talked about on every #MedicareForAll post. This thread is not for that. It was the little things that surprised me.

2/ It starts off in a pretty similar way. Call the hospital, make an appointment, go to the hospital. Enter through the main foyer (past the guy on the grand piano, which I grant you is a bit weird) get in the lift and go find your specialist clinic. Just like home.

3/ I get lost easily so I asked the guy on reception which floor I needed for the ENT clinic.

“Which one?” He asks.

There’s a confused few minutes of ‘I just asked you that question’ back and forth until he explains that there are Multiple ENT clinics. In the same hospital.

4/ Pretty much all the specialist clinics have to compete with comparatively identical specialist clinics in the same building, on the same floor even. So every clinic has a name. And a brand. And a shopfront. And a slogan. And posters. Like this one:

5/ This makes hospitals look like exactly like shopping malls; Row after row of little glass fronted shops, but instead of mannequins or Knick-knacks for sale it’s waiting rooms full of sick people.

6/ Don’t get me wrong, I know the power of a good brand. But window shopping a healthcare provider based on little more than a yelp review and how much I liked their slogan is a totally new experience.

7/ I am totally unqualified to judge the efficacy of a healthcare professional; I have no idea which one I should be giving my money. But in this weird world of private medicine, I am a consumer not a patient, and therefore I have choices. Lots of them.

8/ For those unfamiliar with the NHS, choices aren’t really a thing. You go to the one and only specialist department at your nearest hospital, you see one of the qualified Doctors and then they tell you what you need to do to not be sick any more. Lovely.

9/ A lack of choice is very reassuring, but only because there is literally no incentive for the qualified, informed person giving you the advice/telling you what you to do, to do anything other than make you better in the most appropriate way possible.

10/ I don’t know what it is about the private healthcare experience but it’s literally filled with choices:

“If you take X you have a 20% chance of it fixing your thing. Or I can book you in for surgery under general anaesthetic this afternoon and definitely get it sorted 100%”

11/ Listen Dr. Anon: I am the least qualified person in this conversation to be answering that question, but don’t we think jumping straight to invasive surgery is a bit of a big step?

12/ Theres a bunch of reasons why it’s like this; of course when your insurance is paying for medicine, there’s an incentive to charge a fortune. It’s not like the patient will ever see those costs. Not that I think all/any Doctors see it like that, but the incentive is there.

13/ It’s more than that though. When you view patients as consumers and you’re essentially competing for their attention, you hold their attention (and their money) when their subjective *experience* is that of the best possible care.

14/ think of it like this: if you go in with a common cold and the doctor takes you for a spin in an MRI machine, then your experience of being looked after and cared for makes you far more likely to stick around. Doctors are incentivised to serve your wants, not your needs.

15/ I always thought that it was weird when patients on American TV shows insisted to their doctors that they needed a second opinion. In the UK, second opinions are what Doctors say when they want to show their colleagues the x-rays from your weird and embarrassing A+E visit.

16/ In a private system, it makes total sense. A Doctor says something you don’t want to hear, or who isn’t up for giving you a raft of unnecessary tests? Find another doctor.

17/ Even if you’re not hot-swapping your Doctors, you as an individual have a lot more personal responsibility for your own care. A huge and surprising example - I look after my own medical records. X-rays and imaging and all.

18/ That makes perfect sense given the rigmarole involved in moving anything between two different private companies. Ever changed telco and kept your old number? It’s like the two companies resent talking to each other. And that’s just 8-10 digits.

19/ In summary - was it an unpleasant experience? Yes of course it was, it’s a hospital. Stupid question.

Seriously though, it was... ok. The standard of care was great, but I suspect no better than the NHS. The decor/pianist in the waiting room was nicer than my old Local A+E

20/ However... I felt more alone and isolated in the experience than I did back home. More lost in a sea of complicated and difficult options. More scared of the unknown.

21/ Even without including the ungodly costs and stupid insurance company shenanigans, the #NHS wins this for me, hands down. Beware Tories selling privatisation as a solution; it isn’t a solution you want. Trust me.

22/ one final thought:
Trust is always a massive part of the doctor/patient equation. At home I have to trust in the system; here I have to trust in individual Doctors. I am totally unqualified to judge a doctor on my own, but all of us, together, can make a system work.