A couple of days ago here in Amsterdam, we came through one those medical Euromoments that American tourists love to tell about back home. We have nothing to add to the conventional wisdom but I'll tell the story anyway. Plot spoiler, it ends well.
Anyway, Mrs. Buce came home from a day on the town experiencing those symptoms you know are probably nothing, but could be something awful. A brief Google inquiry proved equivocal, so we made a phone call to the lady who had delivered our apartment keys. Oh, she said, there is a doctor right next door. I mean literally. Next door.
We popped on over--this was about twenty to five in the afternoon and sure enough, there was a little doctor-symbol. We opened the door into a long narrow hallway. We could see a light behind an open door at the back. There were two empty chairs. Almost out of sight in a recess at the top of a stairway was a woman seated behind a little tea-table with an Apple laptop. After about three questions, she said--well, the doctor can see you in a few minutes but he has to make a couple of phone calls first. Do you have insurance? Tourists? Well, you'll have to pay now but we'll give you a receipt to take home.
Sure enough, after about five minutes, a slender little man in levis and open shirt popped out from behind the lighted doorway. Indian, I'd guess, though more from the name on his card than from appearance. He took us back to a largeish, mostly empty, room, where he seated himself behind another Apple laptop. I say "mostly empty:" actually, there were bits of apparatus in various corners that looked like they might be diagnostic equipment. There were some shelves with piles of papers that might have been document unfiled since the Great Tulip Mania.
Mrs. B gave her her account. The doctor (he is a doctor, yes?) responded quickly that he didn't think it was anything to worry about. He took one brief look at the trouble spot and said--no, probably nothing. But if it gets worse, you can come back. And let me give you the address of an all-night first-aid center. Most of the conversation was reassurance; he did indulge himself with some not-so-sly digs at the excesses of US medicine. And he fielded a couple of phone calls from (as he said) the hospital, reporting on patients he had seen earlier in the day. His Iphone ringtone is the quacking duck.
And then he typed a bit on his laptop and printed us on a receipt and sent us off. The girl at the desk took our money? Visa? No, but there is an ATM in the street if you need it. And we were on our way.
I know, I know. The point is the total non-eventness of this event. And the low overhead: one front-desk person, but no nurse, no nurse practitioner, no physician's assistant--and most of all, no biller. Here, I suppose I echo Paul Krugman's point about as defining feature of American medicine, i.e., the amount of time and money we spend establishing liability for (i.e., "getting out of") paying claims. Had we had a local card, I suppose the young woman would have slipped it into a card-reader and that would have been that. There is also--I am more tentative here--the question of malpractice. Is it so that the doctor can be casual because he doesn't have to worry about being sued? Anyway, the story is that there isn't any story and that's the story. And the ringtone duck.