An American Hospital
30 August, 2012

 

I just spend several days with somebody in a hospital in America. Other than in a maternity ward, I had not done that before. I was with somebody who had a serious problem and ended up needing an operation. The comparison between the how Georgian and American hospitals function was striking.

 

 

The first think you notice is the number of nurses, many of whom are men. There are very few doctors, and they are as likely to be women as men.

In this case, many came from India. In Gerogian hospitals there seem to be lots of doctors, few nurses, and the doctors are always Georgian. Also in Georgia, the nurses there are, don't seem to have very clear roles or responsibilities. It is the doctors who not only decide things but actually do things. In the US on the other hand, doctors come in briefly and decide things for the nurses to implement. It will always be a doctor who decides something relating to treatment, a nurse never will but the nurses are ranked in what they do. Some can do a large variety of procedures, other more junior nurses do fewer.

 

The second noticeable difference was procedure. At every step, from admission to the hospital, to diagnosis, to the release, there is very strict and detailed procedure and rules. Every time a nurse gives some medicine they ask the patients name and birthday to be sure they are dealing with the correct person. There are many checklists. The answers to the checklist questions will dictate what happens. When the patient is categorised a certain way, the patient is treated in strict accordance with that categorisation. It is like a factory in that way. The system is set up so that there is very little individual choice in courses of action. Only doctors can decide anything, and then things are implemented very strictly. If they judge a patient as being at risk of falling down, they say she or he can't walk or can only do this or that no matte what the patient wants. Everybody use hand sanitizer every time the enter or exit the patients rooms which means hundreds of times a day. The idea is to prevent an individual act from creating a risk to the patient. And as far as I can see it works.

 

With the excpetion of surgery the doctors are decision makers and they do that quickly but spend a great deal of time consulting with peers. The doctors come in, ask questions discuss, inform the patient and then leaves. When they leave, they went to the office of the ward and discuss the diagnosis with other doctors for quite a long time. I listened to them on the phone and they were calling specialists in other parts of the United States saying what they had seen and asking questions. At least in the cases I saw they spent much more time talking to other doctors over the phone discussing the patients diagnosis than they did with the patient.

 

The hospital we were in was not new; almost a hundred years old, so was in no way luxurious. The main difference was that it was much cleaner than Georgian hospitals I have seen. They obviously spent a great deal of money on people and supplies to clean. The equipment was not that different. I would say the big equipment difference was in diagnostic, magnetic resonance scanners which in our case were important. But the non-diagnostic equipment, was the same.

 

We didn't pay. In fact nobody asked us to pay while we were there. I don't know if this is by law or simply they way they do things. There were a great number of papers to sign in general, before the surgery saying the doctor had gone over the risks, and upon admission. Towards the end of the visit somebody came to establish the identity of the patient, where he lived, if he had medical insurance, and what type of government assistance he may be eligible for. But we never paid anything, although the patient signed paper saying it would be his responsibility to pay. That is very important. Health care is private in the US. Normally if you don't have a job, you don't have insurance and have to pay by cash. And it is very very expensive. So the fact that we could go to a private hospital and get all that service is important. I think it is mainly because of the importance of a person's credit rating in the US. If the patient doesn't pay now or doesn't come to some agreement with the hospital, and the hospital reports him, then his credit rating will be destroyed and it will be very difficult to borrow money or have any relationship with a bank for many years. That system is not yet very strong in Georgia. Also the US is pretty high on social trust. Many people from post-Soviet countries come to the US and view it as naive but really for the most part people tend to trust each other.

 

Some high quality medical facilities are being built in Georgia and there are increasing number of people who are coming from abroad to be treated in Georgia. The question is, will these facilities have very well trained nurses, will they have very strict and comprehensive procedures, and will they be clean? But perhaps the most important question is what happens when a citizen of Georgia needs treatment and doesn't have any money or insurance? And what should happen?

 

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