An appointment at the National University Hospital (NUH)

It now fascinates me how hospitals work and function across continents. I have now experienced three: UK, India and Singapore. These are my observations of things that ‘stand out’ as different to me.

The UK

Coming from the UK I am very fortunate to have had access, and used, ‘free’ (paid by my taxes) health care. It makes a tremendous difference in going to see a doctor and not having to worry about the costs of procedures when referred to Hospital for treatment. There may be waiting lists for non urgent procedures but I have never had to wait longer than a week for anything under the NHS. It’s a great system. It takes no account of ability to pay – it is a free to use service with a nominal standard charge for prescriptions. It is only when one travels outside the UK (and EU) that makes us realise how very fortunate we are to have the NHS.

Hospitals however tend not to have great train links and access by public transport may be via a bus but more likely people drive and park at Hospital (and get charged a lot for it by a private company managing the car park). It’s not the greatest idea the UK Governments have ever had.

India

Indian private hospitals were a real eye opener about how medical professionals are pressurised into prescribing (selling) specific drugs and treatments, with the aim of making money. Now, don’t get me wrong, ALL of the medical professionals were exactly that – professional. Their skills were good, diagnosis spot on and treatment good. However, I soon discovered that there might be a wide range of drugs that could treat a specific ailment but Drs would only prescribed the one that was available at their hospital only. Clearly in some deal with the pharmaceutical industry.

Everything had to be paid for in advance: payment before you see a consultant, payment before having a blood test, payment before having an X-ray. The consultant would diagnose and prescribed and before you could proceed you had to ‘queue’ (this is India, nobody queues and they all try and push in if you do) and wait to pay before proceeding. A child in agony with a broken arm had to wait for an X-ray whilst you paid for it. Only once a receipt was in someone’s hand would things progress. It was a real shock to the system. As was the price of consultation fees being tripled or quadrupled in front of my eyes (the computer screens face the customer) just because I was an expat. (They deleted the normal fee and overtyped it.) When I complained they just said take it or leave it. Incredibly infuriating.

In addition the hospitals were full of mosquitoes. There would be someone regularly sweeping the Hospital with a spray or electrified bat killing mosquitoes. I did think that anyone unfortunate enough to have to be an inpatient was more likely to leave with Dengue than anything else. The two local hospitals to us were also next to or were still building sites. Dust and dirt everywhere surrounding them. You have to drive there (or get a cab – but let’s no dive into that can of worms here). Generally speaking it was a stressful system.

Singapore

I’m rather glad that my yearly check up appointment fell after we had moved to Singapore (I just skipped them in India in the end – far too stressful). I arrived at the MRT (train) station at the hospital and found that the entrance to the hospital was via a shopping mall. I was initially confused – was I in the right place? Hospitals in the UK tend to be on separate campus sites from anything else and whilst there may be a shop and a pharmacy and possibly a florist, it certainly was a medical building and not a shopping mall. But yes, I was in the right place. Signs for different departments and wards hung above the bakery.

The hospital entrance from the MRT

There was no reception to assist with directions to whatever department or ward, I just wandered up the escalators in the hope that I would find something familiar or a sign that would help. I passed Burger King (tempted but I didn’t) , Starbucks (picked up a coffee on the way out), food Courts, and shops selling a wide variety of stuff. I kept going up the escalators. I finally found a sign that had something familiar from my appointment information and I followed it diligently. Up more escalators, (passing signs for various wards and departments) across a glass walkway (with a pianist playing a grand piano underneath) and into a building that looked more Hospital like.

Down escalators and into the first reception looking area I found. The kind person gave me directions of where to go. Back outside, along the taxi rank, back inside, round the corner, up the stairs….I finally found the department and clinic I had been searching for – 30 minutes after I arrived. (It was a good job I came early for my appointment and it wasn’t urgent.)

I was registered as a new patient at a separate registration desk. Only my ID card required. (In India we had to take passports, visas and insurance documents). Height and weight taken (confirming I still haven’t grown a centimetre over the last 30 years and I am overweight. Oh the joy. Such fun.) Then blood pressure was taken (low and normal as usual). I was then given a ticket for my appointment (time stamped at 4.37pm) and directed to one of the side waiting areas besides some consultation rooms.

All of the staff were friendly, helpful and cheerful. The appointment numbers pinged on a screen advising people it was their turn and which consultation room to go to. I sat and waited, having already been told that the Dr was over running and I would be waiting an hour. As my appointment was late afternoon I had anticipated a wait and taken a book with me. I sat a read as various people wandered in and out of consultation rooms, with and without babies and children. The busy clinic was becoming quieter. At 6pm lights started to be turned off in consultation rooms and the cleaning team started their routine. It was about this time that a nurse advised me that there would be a further delay due to a “special case”. Fair enough. This is a Hospital and I’m here for a routine non urgent appointment other people needing urgent care should indeed be seen before me. I waited. At around 6:45 pm I was finally seen by a wonderful consultant.

Now the point I am making here is directed as the moaners in the UK about having to wait a couple of hours in a clinic or at A&E. It is the same the world over whether you are paying or not. Drs treating human beings need the time to diagnose and treat everyone effectively. Sometimes that takes a little longer than anticipated and schedules run over. Sometimes an urgent case may need to be seen ahead of you. That’s the nature of medical emergencies and priorities. Don’t whinge about the NHS waiting times when it is the same when you’re paying for it. Be grateful that the Drs and nurses don’t sign off work when their hours are up and stay on to finish their clinic or see all their patients. When I left the clinic there were two nurses, a doctor and the cashier (to take payment) and one more patient left to see. Everyone else had gone home. These dedicated professionals worked beyond their already long 12 hour shift to ensure everyone was seen.

Anyway, back to the clinic. Appointment concluded and next yearly check up appointment given (how efficient) and follow ups etc all organised before I left the consultation room. With a handful of leaflets, advisory information and appointment cards. I was so impressed. Back to reception and the cashier pings your number on the screen when billing is ready. Swift payment on the card (thank goodness for insurance) and off I went…to retrace my steps through a now dark and desserted Hospital to find my way back to the shopping mall and MRT. It was quicker this time, even with a coffee stop.

Final thoughts

No no one wants to go to hospital (or enjoys it) but I have to say that this pristine hospital with friendly helpful staff was the nearest you can get to making it as non stressful as it can be.