Medical Anthropology

No picture on this one, for reasons that will become obvious...

I was (embarrassing number of years old) before I realized -- I mean, really had it sink in -- that perhaps the US didn't have the best everything on the planet. I think this is normal for most people, and I think it's especially normal when it comes to medical systems. I mean, those are thoroughly grounded in science, aren't they? And science is universal -- so of course they should all be identical, and, if they're not, ours is right. Right?

In rural Thailand, there are livestock roaming the hospital, and if your visiting bipolar friend needs Lithium because he's about to run out, you just walk around until you find a bored 20-something doctor playing games on her phone and ask for it, and she'll consider for a minute and decide writing a script is less effort than arguing with you, and do it.

In Mumbai, the doctors ask whether you're veg or non-veg (this doesn't seem like such a bad practice, honestly). At a routine gyn visit, when the doctor learned that I was unmarried, he told me he would only do an external exam. When my 30-something self burst out laughing, he spent the rest of the exam silently but strongly radiating the accusation that I was the Whore of Babylon.

In England, you get a letter in the post inviting you for a flu shot, or for your pap smear, or for whatever else you ought to be having done. I like this a lot, because I can never remember when I'm supposed to get routine care, and always feel like I'm bothering an over-burdened system to go in for something that isn't an emergency. Getting a friendly written invitation is very civilized.

I really didn't want a pap test, not least because they're called "cervical screenings" here, and that's pronounced (per TH) "cer-VYE-cal," and I wasn't sure which was worse, to obstinately call it "CER-vicle," or to refer to it as a "pap smear" if that's not a meaningful term here. But I was overdue for one even before accidentally moving to another country a year ago, and, anyway, like everyone else, I've heard horror stories about the NHS. Might as well get on the wait list and deal with the appointment six months from now. "Of course," the friendly receptionist said, when I phoned on Monday (asking for the cer-VYE-cal screening; social anxiety trumps standards). "How about Wednesday?" "THIS Wednesday?" I sputtered.

So, Wednesday I strolled to the medical center that's a mile down the road (everyone is assigned to their nearest, though you have some scope to change that if you want). I presented myself to reception, and waited for the clipboard. You know, with the ten pages of stuff about insurance and billing and family history and HIPAA and everything else. There was no clipboard. I had brought every form of British ID that I've diligently acquired: my residence permit, my learner's driver's license, my NHS number, my US passport. They did not ask for a single piece of ID. (I was upset about that later, and raised it with TH as a serious flaw in the system. "Who'd want to take your pap smear in place of you?" he laughed. "Well, of course, someone who doesn't have their own insur....oh." I said.

I waited perhaps five minutes before a TV screen invited me to proceed to an exam room. I hate not knowing the protocol in a given situation, and I had interrogated TH before I left for the appointment: when I go to the exam room, do I immediately take my pants off? "Er, perhaps best to wait for the nurse and make sure you're in the right room," he advised.

The room was not the standard US doctor's office room: you know, aggressively sterile, full of aluminum countertops and jars of prodding instruments and swabs, and posters on the wall of the interiors of bodily cavities, and perhaps some unidentifiable large equipment that vaguely suggests that some unknown percentage of people who have previously visited these rooms has suffered abrupt deterioration necessitating immediate, heroic, and very expensive technologically-assisted intervention. I also truly hate those kinds of rooms. This was a clean and practical space, but it was also clearly a former residential house. It did not cause my blood pressure to spike in the way that those hyper-clinical sani-rooms do. ("Medical theatre," TH sniffed, when I told him about this later. "You're paying for the experience, and the customer wants to see value for money. They want all the swabs on the counter.")

The nurse was slightly nervous (not surprising, as my file probably said "is au fait with worms" and not much else), but extremely warm and chatty, and completely unhurried. We talked through things, I confirmed I was in the right exam room and dropped trou, and we proceeded with what was a fairly familiar routine. (No stirrups, though -- they don't have them here. And why on earth would anyone, really?) I was out the door a leisurely 20 minutes or so later, not having had to return to reception. 

You know that thing, where you wait for weeks for a bill from your insurance company, and then have to decipher all the codes, and then check they did it correctly (one time I was billed for, I shit you not, my son's circumcision. For those who don't know me: I don't have any children), and then a few weeks later you get a bill -- or two; you never know how they're going to divvy it up -- for labwork, and you just have to hope the lab the doctor chose was in-network? And then even if they are, you have to create a login on the medical center's website and submit your copay and then set a reminder to log in a few weeks later to make sure there's nothing left after everyone has allegedly paid? There won't be any bills whatsoever here. (After all, they invited me.) The entire experience was 100% paperwork-free, aside from that initial letter, from start to finish.

Anthropologists aren't supposed to be prescriptive: "right" and "wrong" are culture-bound and relative, and meaningless across different belief-systems. I'm not an anthropologist, though, so I'm just going to say it: Yeah. This is the right way to do medical care.