How Does Hospitalisation Work Out In Your Country?

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No_Mind
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How Does Hospitalisation Work Out In Your Country?

Post by No_Mind » Fri Mar 03, 2017 5:52 am

This is how hospital visit for pre-planned surgery happens here. I would really like to know if it is same in U.S, U.K, Australia and other countries.

Characters -- James and his wife Susan. Susan has terrible upper abdomen ache at 11 PM on Feb 15.

Feb 16 7 AM -- she is first treated by general practitioner or GP (called family physician) at her home and given Tramadol injection.

Feb 16 11 AM -- James decides to take his wife to nearest big hospital OPD (outpatient department). At 2 PM she is seen by a gastroenterologist who suspects gallstone and prescribes an ultrasound and MRI of abdomen. Ultrasound is done but MRI not done that day.

Feb 17 9 AM -- Susan undergoes MRI and waits for the gastroenterologist whose clinic hours are from 12 PM. At 2 PM gastroenterlogist confirms gallstone and suggests to her name of a reputed hepato-billiary surgeon at same hospital. But since the surgeon is busy he cannot meet the patient that day.

at this point usually Susan should seek second opinion from another gastroenterologist.

Feb 18 2 PM -- Susan meets the HB surgeon who prescribes pre-operation screening tests (fasting sugar, post prandial sugar, complete blood count, tests for HIV and Hepatitis C, liver function test, creatinine, ECG). Since Susan has already had food, no blood tests can be done on that day.

at this point usually Susan should seek second opinion from another HB surgeon

at this point James should check if other hospitals are better / cheaper etc. Looking for a new hospital is skipped by most.

Feb 19 Sunday -- all labs closed

Feb 20 8 AM -- Susan has blood drawn for fasting sugar and liver function, complete blood count, creatinine, HIV and Hep C test. She has coffee and 2 slices of cake at 9 AM. At 10 AM she has ECG done. At 12 PM she has lunch. At 2 PM she is tested for post prandial sugar.

Feb 21 11 AM -- James puts together all documents (prescriptions and reports) and applies to medical insurer for permission to proceed with operation.

Feb 23 -- insurer gives permission to proceed. till now Susan has been an outpatient

Susan cannot have operation on 25th because next day is a Sunday and surgeon will not be available in case of any emergency. Only resident medical officers are available on Sunday.

Feb 27 10 AM -- Susan is admitted to hospital in morning. At 1 PM she has gallbladder operation. At 2:30 PM she is shifted to to post operation observation ward and at 4 PM returned to her hospital bed/cabin (in case it went south she would have ended up in some kind of intensive care ward).

Feb 28 -- she is kept under observation.

Mar 1 11 AM -- HB surgeon and resident medical officer on duty signs discharge certificate. She is released at 5 PM after insurer clears her dues with hospital. Insurer pays for hospital stay, surgery charges between Feb 27 and Mar 1.

All expenses prior to Feb 27 (3 x doctor fees, MRI, USG, pre-op screening costs) has to be claimed separately by James from medical insurer.

On the days marked red, James has to take leave from work (at least 6 days and probably 7; will be 8 - 9 days if second opinion is sought). The days are not consecutive that James can take one week long leave but take leave as needed.

Is it the same in other countries? Such as is it that in U.K James can just go and deposit Susan at hospital on Feb 16 at 8 AM and go to work and visit her once or twice daily for duration of her stay? It cannot happen here because insurer would not agree to it. It could happen if someone paid it out of own pocket.

I would be glad if anyone could throw some light on this.

Note i -- I am not speaking of immediate hospitalisation in case of heart attack but a pre-planned surgery such as gallstone where the patient is too weak to be left alone in a hospital as out patient and too strong to be admitted as an in patient.

Note ii -- all steps marked in italics should be done but James will be sacked if he takes any more leave.

Note iii -- Feb 21 and 23, insurer steps could be eliminated if one goes for an all cash procedure.

I am asking because in my extended family I am the doctor and hospital expert guy. Due to a strange coincidence I had to take care of three surgeries in three different hospitals (all pre-planned) in last 10 months and I am quite curious about other countries and how it happens there.

Hospital stay and hospital visits are the most traumatic things that can happen (apart from getting tangled in a legal case or being sued) to one.

Is it more streamlined in U.S or U.K or Europe? Here by the time the patient Susan is ready for release, James is ready to be admitted for exhaustion.

:namaste:
Last edited by No_Mind on Fri Mar 03, 2017 2:22 pm, edited 9 times in total.
"The struggle itself toward the heights is enough to fill a man's heart. One must imagine Sisyphus happy.”― Albert Camus

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No_Mind
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Re: How Does Hospitalisation Work Out In Your Country?

Post by No_Mind » Fri Mar 03, 2017 6:14 am

No_Mind wrote: Characters -- James and his wife Susan. Susan has terrible upper abdomen ache at 11 PM on Feb 15.

Feb 16 7 AM -- she is first treated by general physician GP (called family physician in U.S) at her home and given Tramadol injection.

Feb 16 11 AM -- James decides to take his wife to nearest big hospital.
At this point what do you guys do? OPD or Emergency (E.R) and what happens next? How does it work out?

:namaste:
"The struggle itself toward the heights is enough to fill a man's heart. One must imagine Sisyphus happy.”― Albert Camus

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Kim OHara
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Re: How Does Hospitalisation Work Out In Your Country?

Post by Kim OHara » Fri Mar 03, 2017 6:44 am

I can't help much because my experience of the hospital services is (thankfully!) limited, but can say that we would never have to delay anything because we have to wait for an insurance decision. Our private medical insurance cover is spelled out in detail when we take out the policy so at each step we know whether we have insurance or not.

On the other hand, having to take time off work to assist a family member - transport, etc - is not at all unusual. There is a gap, as you say, between a patient who is not weak enough to be admitted and not strong enough to manage without help.

:namaste:
Kim

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No_Mind
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Re: How Does Hospitalisation Work Out In Your Country?

Post by No_Mind » Fri Mar 03, 2017 6:48 am

Kim OHara wrote:I can't help much because my experience of the hospital services is (thankfully!) limited, but can say that we would never have to delay anything because we have to wait for an insurance decision. Our private medical insurance cover is spelled out in detail when we take out the policy so at each step we know whether we have insurance or not.

On the other hand, having to take time off work to assist a family member - transport, etc - is not at all unusual. There is a gap, as you say, between a patient who is not weak enough to be admitted and not strong enough to manage without help.

:namaste:
Kim
Here too we have insurance at every step but for pre-planned surgery the insurance company will look at MRI, USG etc tests just to make sure that a tummy tuck is not being passed of as a gallstone surgery or a lasik eye correction surgery as operation on a tumour inside the eye (basically to eliminate plastic surgery dressed up as pre-planned semi elective surgery).

Hence 2 days approval time is needed.

In case of emergency hospitalisation no prior approval is needed from insurer. Since emergencies require immediate attention from insurer's back room boys, the pre-planned procedures (called semi elective in some countries) takes 48 hours to get approved.

So if I understand you correctly only Feb 21 and 23 can be avoided. But rest is same? You cannot just deposit the patient on Feb 16 at 8 AM and expect everything to work itself out?

:namaste:
Last edited by No_Mind on Fri Mar 03, 2017 2:23 pm, edited 1 time in total.
"The struggle itself toward the heights is enough to fill a man's heart. One must imagine Sisyphus happy.”― Albert Camus

Caodemarte
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Re: How Does Hospitalisation Work Out In Your Country?

Post by Caodemarte » Fri Mar 03, 2017 1:35 pm

What country are you in?

In the US it all depends on what insurance you have, what state, what doctor, what hospital, specific illness, etc. It can be a nightmare figuring out what specialist is part of which insurance network (non-network doctor is paid much less by the insurance company so the patient pays more out of pocket). Doctors' offices investigate if the insurance company will pay for a specific operation (and how much they will pay for with you making up the difference) before treatment. Sometimes they get it wrong and the patient gets an unexpected bill.

I can't imagine being able to just drop off a patient in a hospital and have them do all the tests and surgery in one go, unless you are very, very rich and paying a premium.

Lux
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Re: How Does Hospitalisation Work Out In Your Country?

Post by Lux » Fri Mar 03, 2017 1:51 pm

I can give an idea from the UK side of things because I am undergoing it right now.

11:00 - 4th February -- A&E(Accident & Emergency, or ER to our colonial cousins) visit with severe abdominal pain. I suspected and was in the process of getting a scan for gallstones. Admitted immediately, given various different medicines via IV drip, gave 5 blood samples, urine sample and had a chest X-Ray because the nature of gallstones causes the pain to resource through to your back and shoulders, so they wanted to check my heart. I was in and discharged pain free with an appointment for the Monday for an ultrasound scan.

09:00 - 6th February -- Ultrasound to confirm gallstones. Told to wait for my results. Waited for about 30 minutes and then met with the on-duty consultant(surgeon), a registrar and and two other doctors. They confirmed I had gallstones and the nature of my problem(gallbladder has a narrow 'neck', had gallstones inside it and the wall of the gallbladder was inflamed). Went over what pain medication I was taking and how effective it was; I told them I was taking cocodomol(morphine) but that it wasn't working anymore so they prescribed me Tramadol which is about two-three times stronger and walked me through how to go forward until I get my pre-operation assessment. Was home by 10:30.

09:50 - 1st March -- Pre-operation assessment with the surgeon. Discussed the nature and frequency of my problems with pain/attacks, went over the procedure and risks and was told he's going to put me in as a high priority and in to the general pool of surgeons, so not just him, as well as short notice, so I can get attended to as soon as possible barring more important operations(cancers and such). Was home by 10:45.

Now I am just waiting for my operation date.

Total cost: £7/$10 for the prescription painkillers.

:namaste:

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No_Mind
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Re: How Does Hospitalisation Work Out In Your Country?

Post by No_Mind » Fri Mar 03, 2017 2:09 pm

Caodemarte wrote:What country are you in?

In the US it all depends on what insurance you have, what state, what doctor, what hospital, specific illness, etc. It can be a nightmare figuring out what specialist is part of which insurance network (non-network doctor is paid much less by the insurance company so the patient pays more out of pocket). Doctors' offices investigate if the insurance company will pay for a specific operation (and how much they will pay for with you making up the difference) before treatment. Sometimes they get it wrong and the patient gets an unexpected bill.

I can't imagine being able to just drop off a patient in a hospital and have them do all the tests and surgery in one go, unless you are very, very rich and paying a premium.
I am in India. So the same process mostly.
Lux wrote:I can give an idea from the UK side of things because I am undergoing it right now.

11:00 - 4th February -- A&E(Accident & Emergency, or ER to our colonial cousins) visit with severe abdominal pain. I suspected and was in the process of getting a scan for gallstones. Admitted immediately, given various different medicines via IV drip, gave 5 blood samples, urine sample and had a chest X-Ray because the nature of gallstones causes the pain to resource through to your back and shoulders, so they wanted to check my heart. I was in and discharged pain free with an appointment for the Monday for an ultrasound scan.

09:00 - 6th February -- Ultrasound to confirm gallstones. Told to wait for my results. Waited for about 30 minutes and then met with the on-duty consultant(surgeon), a registrar and and two other doctors. They confirmed I had gallstones and the nature of my problem(gallbladder has a narrow 'neck', had gallstones inside it and the wall of the gallbladder was inflamed). Went over what pain medication I was taking and how effective it was; I told them I was taking cocodomol(morphine) but that it wasn't working anymore so they prescribed me Tramadol which is about two-three times stronger and walked me through how to go forward until I get my pre-operation assessment. Was home by 10:30.

09:50 - 1st March -- Pre-operation assessment with the surgeon. Discussed the nature and frequency of my problems with pain/attacks, went over the procedure and risks and was told he's going to put me in as a high priority and in to the general pool of surgeons, so not just him, as well as short notice, so I can get attended to as soon as possible barring more important operations(cancers and such). Was home by 10:45.

Now I am just waiting for my operation date.

Total cost: £7/$10 for the prescription painkillers.

:namaste:
Waiting from 4th Feb for gallstone operation can be quite intimidating (because at times sharp pain recurs). Wish you all the best.

So U.S and U.K is about the same as here. No way of just dropping off the patient at hospital and having them take care of umpteen tests and pre-op interview with surgeon and pre-op screening, insurance procedures and preferred network doctors etc and patient family just having to visit twice a day with flowers and cards. Hmm.

The advantage I see with NHS is patient is treated as sort of inpatient before the actual surgery. It reduces the running around and total number of visits.

This cannot be done with private insurer system. The disadvantage of NHS type of system being you have to accept the surgeon you are offered (you cannot say .. I want not only a surgeon but one of the top surgeons in this speciality in the city).

I want to know something .. can you admit yourself for a gallstone operation in U.S and U.K? Here it is quite impossible because they require family or friend to sign consent form not only for the operation but MRI, CT scan, fine needle aspiration biopsy, tooth extraction and any procedure under local or general anaesthesia (ERCP, endoscopy and so on).

Even if the patient is fit (say patient of spondylitis requires an MRI) he/she has to be accompanied by another person for the MRI imaging. It has always seemed to me to be a rather dumb rule.

I have never found a valid reason to want to be a millionaire. But this is one really valid reason. Paying for very expensive healthcare out of pocket is infinitely more preferable to the nightmare of being absent from work for several days at short notice and running around with sheaf of test reports and MRI plates.

:namaste:
"The struggle itself toward the heights is enough to fill a man's heart. One must imagine Sisyphus happy.”― Albert Camus

Justsit
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Re: How Does Hospitalisation Work Out In Your Country?

Post by Justsit » Fri Mar 03, 2017 4:08 pm

No_Mind wrote:can you admit yourself for a gallstone operation in U.S and U.K?
Short answer, have to leave in a few moments, but it depends what you mean by "admit yourself." If it means can you go to the hospital for a pre-planned admission alone (no one with you), then yes, you can be admitted by yourself.

If you mean can you just show up at a hospital and say, "I need gallbladder surgery," then no.

I worked in a US East coast Level 1 trauma center as a case manager/utilization review manager. This is how it works:

A patient must meet certain criteria to be admitted; those criteria are determined by the patient's payor source, based on a meticulously defined set of standards provided by two major companies, Interqual and Millman. When a patient is admitted to the hospital, either through the ER, directly from home/dr.'s office, or preplanned, a representative of the insurance company has a person (the utilization manager) review the chart data against the Interqual or Milllman standards. If the patient meets criteria, the insurance company pays for that day. The chart is reviewed every day the patient is in the hospital. If, say, on day 4 the patient does not meet criteria, the UM will call the physician and tell them that the patient no longer meets and must be discharged. The physician can contest that decision. If the insurance company is not convinced, they will not pay for additional treatment and the patient gets the bill.

This scenario varies a bit if the patient is over 65yo and on Medicare, or is medically indigent and on Medicaid.

Sometimes people think a hospital is like a hotel, you can check in and out at will - they will get a big surprise!

I can expand on this later, if you'd like.

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Re: How Does Hospitalisation Work Out In Your Country?

Post by No_Mind » Fri Mar 03, 2017 4:27 pm

Justsit wrote:
No_Mind wrote:can you admit yourself for a gallstone operation in U.S and U.K?
it depends what you mean by "admit yourself." If it means can you go to the hospital for a pre-planned admission alone (no one with you), then yes, you can be admitted by yourself.

If you mean can you just show up at a hospital and say, "I need gallbladder surgery," then no.
I meant the first one.

The rule is pretty dumb in India that we are not allowed to admit ourselves for a pre-planned surgery or even have an endoscopy done without having a consent form signed by someone else and having someone (family or friend) present throughout the procedure.

We do not have HMO system here. We have PPO only. It gives us flexibility in choosing a specialist but of course it costs more than HMO system.
A patient must meet certain criteria to be admitted; those criteria are determined by the patient's payor source, based on a meticulously defined set of standards provided by two major companies, Interqual and Millman. When a patient is admitted to the hospital, either through the ER, directly from home/dr.'s office, or preplanned, a representative of the insurance company has a person (the utilization manager) review the chart data against the Interqual or Milllman standards. If the patient meets criteria, the insurance company pays for that day. The chart is reviewed every day the patient is in the hospital. If, say, on day 4 the patient does not meet criteria, the UM will call the physician and tell them that the patient no longer meets and must be discharged. The physician can contest that decision. If the insurance company is not convinced, they will not pay for additional treatment and the patient gets the bill.
This part is more or less the same. So as far as I see we have adopted the U.S. PPO model in toto

:namaste:
"The struggle itself toward the heights is enough to fill a man's heart. One must imagine Sisyphus happy.”― Albert Camus

Caodemarte
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Re: How Does Hospitalisation Work Out In Your Country?

Post by Caodemarte » Fri Mar 03, 2017 5:30 pm

Lux wrote:I can give an idea from the UK side of things because I am undergoing it right now...Total cost: £7/$10 for the prescription painkillers...
In the US I can't imagine any medical service so cheap!

dharmacorps
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Re: How Does Hospitalisation Work Out In Your Country?

Post by dharmacorps » Fri Mar 03, 2017 7:02 pm

One of the most unfortunate things about the healthcare system in the US isn't really the HMO structure so much at this point, its the cost of care. I've worked in the medical field for 20 years and seen it get more and more ridiculous, completely out of context for any of the services being rendered or realistic costs. I remember finding out a hospital I worked for charged insurance (even if medicare/medicaid) for reserving a room for an operation (just the room, not doing the surgery, or the doctor, or surgical equipment, just the room) $17,000. And this is an operating room open all day doing surgeries.

Justsit
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Re: How Does Hospitalisation Work Out In Your Country?

Post by Justsit » Fri Mar 03, 2017 8:36 pm

dharmacorps wrote: I remember finding out a hospital I worked for charged insurance (even if medicare/medicaid) for reserving a room for an operation ...(
Health care now accounts for roughly 17% of US GDP as of 2015. It is the premier cash cow of the US economy, with costs
estimated at $9,900 per person annually.

And interestingly, one percent of the population accounts for 30 percent of the nation's health care expenditures. Nearly half of those people are elderly. Medicare spends nearly 30 percent of its budget on beneficiaries in their final year of life.
http://www.thirteen.org/bid/sb-howmuch.html

When I was doing discharge planning, we had a 90 year old patient who had cardiac issues. She and her daughter had decided against having surgery, until the cardiac surgeon came to the floor and heard they had declined. The surgeon went in the patient's room, spoke with them, and came out twenty minutes later with a signed consent form for a 6 vessel coronary artery bypass. The patient had the surgery, and survived, but never regained consciousness and never came off the ventilator, until she died septic still in ICU 6 weeks later. Total cost exceeded $500,000. These types of decisions are what put costs through the roof.

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No_Mind
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Re: How Does Hospitalisation Work Out In Your Country?

Post by No_Mind » Sat Mar 04, 2017 1:23 am

Caodemarte wrote:
Lux wrote:I can give an idea from the UK side of things because I am undergoing it right now...Total cost: £7/$10 for the prescription painkillers...
In the US I can't imagine any medical service so cheap!
But look at how long he is waiting (the primary issue with British NHS).

I was complaining about 10 days before a gallstone operation being too much. He has waited 28 days with pain in the abdomen and still does not know operation date. During this period he cannot do any strenuous work like lift a heavy bucket or change his car tyre; he cannot take a plane ride or be more than 30 miles away from a major hospital because sharp, sudden pain can send him to E.R at any time. On top of which the patient can have severe inflammation of pancreas and associated organs due to delay in removal of stones (God forbid).

As far as cost of Tramadol goes .. it is very old and out of patent medication. Cannot cost much in U.S. too (60 tablets cost $20ish if online information is correct).

It would have been nice if the private medical insurance system allowed one to be admitted and then diagnosed in cases other than emergency (in my example on Feb 16 the gastroenterologist after preliminary physical exam asks Susan to get admitted to the hospital and insurance pays from that point onward).

This would take a lot of stress away from patient's family. They can go to work knowing that tests are being done and that the patient is resting in a hospital setting while waiting for diagnoses and treatment.

:namaste:
"The struggle itself toward the heights is enough to fill a man's heart. One must imagine Sisyphus happy.”― Albert Camus

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Sprouticus
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Re: How Does Hospitalisation Work Out In Your Country?

Post by Sprouticus » Sat Mar 04, 2017 5:43 am

Justsit wrote:When I was doing discharge planning, we had a 90 year old patient who had cardiac issues. She and her daughter had decided against having surgery, until the cardiac surgeon came to the floor and heard they had declined. The surgeon went in the patient's room, spoke with them, and came out twenty minutes later with a signed consent form for a 6 vessel coronary artery bypass. The patient had the surgery, and survived, but never regained consciousness and never came off the ventilator, until she died septic still in ICU 6 weeks later. Total cost exceeded $500,000. These types of decisions are what put costs through the roof.
That poor woman. Her family must have been devastated. And a little angry.
Namo buddhaya

Lux
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Re: How Does Hospitalisation Work Out In Your Country?

Post by Lux » Sat Mar 04, 2017 8:53 am

No_Mind wrote:
Caodemarte wrote:What country are you in?

In the US it all depends on what insurance you have, what state, what doctor, what hospital, specific illness, etc. It can be a nightmare figuring out what specialist is part of which insurance network (non-network doctor is paid much less by the insurance company so the patient pays more out of pocket). Doctors' offices investigate if the insurance company will pay for a specific operation (and how much they will pay for with you making up the difference) before treatment. Sometimes they get it wrong and the patient gets an unexpected bill.

I can't imagine being able to just drop off a patient in a hospital and have them do all the tests and surgery in one go, unless you are very, very rich and paying a premium.
I am in India. So the same process mostly.
Lux wrote:I can give an idea from the UK side of things because I am undergoing it right now.

11:00 - 4th February -- A&E(Accident & Emergency, or ER to our colonial cousins) visit with severe abdominal pain. I suspected and was in the process of getting a scan for gallstones. Admitted immediately, given various different medicines via IV drip, gave 5 blood samples, urine sample and had a chest X-Ray because the nature of gallstones causes the pain to resource through to your back and shoulders, so they wanted to check my heart. I was in and discharged pain free with an appointment for the Monday for an ultrasound scan.

09:00 - 6th February -- Ultrasound to confirm gallstones. Told to wait for my results. Waited for about 30 minutes and then met with the on-duty consultant(surgeon), a registrar and and two other doctors. They confirmed I had gallstones and the nature of my problem(gallbladder has a narrow 'neck', had gallstones inside it and the wall of the gallbladder was inflamed). Went over what pain medication I was taking and how effective it was; I told them I was taking cocodomol(morphine) but that it wasn't working anymore so they prescribed me Tramadol which is about two-three times stronger and walked me through how to go forward until I get my pre-operation assessment. Was home by 10:30.

09:50 - 1st March -- Pre-operation assessment with the surgeon. Discussed the nature and frequency of my problems with pain/attacks, went over the procedure and risks and was told he's going to put me in as a high priority and in to the general pool of surgeons, so not just him, as well as short notice, so I can get attended to as soon as possible barring more important operations(cancers and such). Was home by 10:45.

Now I am just waiting for my operation date.

Total cost: £7/$10 for the prescription painkillers.

:namaste:
Waiting from 4th Feb for gallstone operation can be quite intimidating (because at times sharp pain recurs). Wish you all the best.

So U.S and U.K is about the same as here. No way of just dropping off the patient at hospital and having them take care of umpteen tests and pre-op interview with surgeon and pre-op screening, insurance procedures and preferred network doctors etc and patient family just having to visit twice a day with flowers and cards. Hmm.

The advantage I see with NHS is patient is treated as sort of inpatient before the actual surgery. It reduces the running around and total number of visits.

This cannot be done with private insurer system. The disadvantage of NHS type of system being you have to accept the surgeon you are offered (you cannot say .. I want not only a surgeon but one of the top surgeons in this speciality in the city).

I want to know something .. can you admit yourself for a gallstone operation in U.S and U.K? Here it is quite impossible because they require family or friend to sign consent form not only for the operation but MRI, CT scan, fine needle aspiration biopsy, tooth extraction and any procedure under local or general anaesthesia (ERCP, endoscopy and so on).

Even if the patient is fit (say patient of spondylitis requires an MRI) he/she has to be accompanied by another person for the MRI imaging. It has always seemed to me to be a rather dumb rule.

I have never found a valid reason to want to be a millionaire. But this is one really valid reason. Paying for very expensive healthcare out of pocket is infinitely more preferable to the nightmare of being absent from work for several days at short notice and running around with sheaf of test reports and MRI plates.

:namaste:
Namaste :)

The waiting hasn't been too bad. I haven't really had any major issues at all since that major attack, so I am basically back to normal it seems.

You can't admit yourself as such. You would go to see your doctor, they would determine if it's necessary to send you for an ultrasound scan, depending on the results and other observations(frequency of attacks, etc) you may be told one of a couple things; change to a low fat diet and observe what foods trigger attacks and then avoid them, or if gallstones are confirmed, attacks are frequent and/or severe, or if the gallstones are made of calcium(I believe it's calcium) that can lead to greatly increased risks of cancer in the future, it'll likely be removed.

You'll then be referred for an operation and have your pre-op assessment etc with the surgeon.

I didn't require a third party to sign any consent forms either, no.

:namaste:

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