Getting sick in the U.S.

I recently had the misfortune of catching a bad cold. Being in my own country during an illness is something I have taken for granted, as I can filter out the peculiarities of the experience and focus on getting better. However, as an interculturalist I note of the process, and below I will explain how “going to the doctor” generally works in the U.S.

You Decide Where to Go for Care

The most basic step for many people used to be calling their primary doctor. Sometimes called a general practitioner or family doctor, this person is, in an ideal world, the first point of contact for all medical issues. However, if you have just moved here, you may not have a doctor yet. And, even if you do have one, you may not be able to get an appointment. If you have insurance, and go to someone in your network, this is the most affordable option. While all insurance plans vary, you should expect a small copay of $10 – $35.

However, many people either do not have a primary doctor or cannot make an appointment to get in as soon as they need to. Hence the popularity of the Urgent Care/Walk-in Clinic. These are places where medical providers can see you more or less instantly (aside from some waiting until the person ahead of you has been seen). It doesn’t matter if they have ever seen you before in your life, or if they will ever see you again. You simply show up, see a nurse practitioner or a medical doctor, are diagnosed, and, if necessary, receive a prescription for medicine. Sometimes these are in strip malls, medical office complexes, grocery stores or pharmacies. This option is more expensive; depending on your insurance, you should expect a copay of $30 – $75.

3. If neither a primary care doctor or an urgent care clinic will suit you, the Emergency Room is your last resort. This is a difficult one to explain to people who aren’t from the US. You really only want to go to the hospital when you are facing a truly life-threatening or dangerous  medical situation.

It is not at all like in Korea, England, or other countries where the Hospital serves as first point of contact for any and all medical issues that arise. (The culture shock goes both ways: my family was recently in England and referred “to hospital” when my teenage cousin had a bad cold). Once you are at the Emergency Room, all non-essential cases will wait, sometimes for hours. So, think carefully about whether you want to be sitting there at 2 am surrounded by other sick people, or whether your sprained ankle can wait until the next day. Also, this is BY FAR the most expensive. If your health care issue turns out to not be a legitimate emergency, or if you aren’t admitted, your insurance might not even pay. Even then, depending on your insurance plan, you could still end up owing at least a couple hundred dollars, and even thousands or tens of thousands.

You Check-In

Regardless of the method you choose, there are some similarities to the process you’ll follow once you arrive at your chosen care site.First, you’ll have to sign in. This usually includes printing your name and the time of arrival on a sheet of paper that is attached to a clip board at the front desk.

Next, several things will happen more or less at the same time. You will be given forms to fill out, where you will need to state your full name, address, phone number, sometimes email, all of your health insurance billing information, and the reason for your visit. Sometimes you will also be asked to provide emergency contact information as well as a more complete medical history. Additionally, due to health care privacy laws, you may be given a paper which covers the practice’s privacy policy, and may be asked to sign a form saying that this was given to you. These forms can take as few as two minutes or as many as 15 to complete.

You will also need to show a photo ID and the health insurance card. The desk worker will tell you how much you need to pay, based on the type of health insurance policy you have. There is sometimes the opportunity to negotiate (especially if you are paying in cash, without insurance), but in general you should expect to pay the full amount that is due before you are seen. With insurance, this usually just means the copay.

After that, you’ll go back to the row of chairs and wait. You could be waiting for two seconds or thirty minutes (or much much more, at an emergency room, depending on the urgency of your case).

Your Name is Called

When it is your turn, an orderly will open the door and call your name. If you have a name that might sound foreign to the office staff, pay close attention as they may be calling you with incorrect pronunciation. It is totally permissible for a spouse or parent to accompany you back to the examination room. In fact, it is a good idea so that someone other than the sick person can listen to the doctor’s instructions and contribute helpful information. You may need to verbally confirm to the medical staff that you want the other person in the room with you.

You may or may not be weighed on the way to the exam room. Once in the room, you may be instructed to sit down on padded exam table covered with a protective tissue paper lining. There will usually be at least one extra chair in the room for the doctor, and another for a family member. The orderly will likely take your temperature, blood pressure, and even pulse and blood oxygen. They will also ask you if you have any allergies, and what medicines you are taking. Be sure to tell them EVERYTHING, including herbs, supplements, or over-the-counter treatments.

Sometimes he or she will then ask you questions about why you are here, how long you have had symptoms, etc. This is a time to communicate very directly, succinctly, and clearly, but you should not censor any information that you feel might be important. Staff are not generally trained to read between the lines or to think holistically; they will base your treatment almost entirely off of what you TELL them verbally. If you are more comfortable having your family member speak for you, you (the patient) should tell the orderly and the doctor this, as it is typical in the US for medical staff to speak directly to the patient.

After a few minutes, this section of the visit will be done, and the orderly or nurse will leave the room. Depending on your situation, they may ask you to take off your clothes and to put on a paper drape. You will now sit in the empty room and wait for the doctor, sometimes up to twenty more minutes. This is normal, so don’t take it personally or get too impatient.

You See the Doctor

Finally, the doctor or nurse practitioner will come in, after knocking gently. He or she will introduce him or herself, and will ask you why you came. Although they will glance at the information you have already provided, you will likely have to repeat everything that you have already said. Again, try to list specific symptoms with specific times at which they appeared and worsened. Do not assume that the doctor will know something is wrong if you do not state it aloud. If the doctor presses you or asks you more questions, do not feel intimidated. This is their way of showing that they take your condition seriously and want to understand it better, so try to answer as clearly and completely as possible.

Once you have told the doctor or nurse practitioner the problem, he or she will then physically examine you. For example, she may place a stethoscope on your back, under your shirt, to listen to your lungs while you breathe. Or, they may touch your skin to examine a rash, or shine a light into your eyes to examine your pupils. If something makes you feel uncomfortable, you have a right to tell them, but if they are not able to conduct their exam, it may impact their ability to correctly diagnosis. If necessary, the doctor or nurse practitioner will also order additional tests (sometimes called lab work), which could include drawing your blood or getting X-Rays or CT scans. You do not have to follow their recommendation if you do not want to get these tests, but you should inform them if there is some reason that you cannot or do not want to.

After the exam, the doctor or nurse practitioner will state the diagnosis (what is wrong) and will tell you what to do in order to recover. If it is deemed that you need antibiotics, or another medicine only available by prescription, then you will receive a piece of paper that enables you to get it filled. Pay attention to any instructions as the prescription will not always have the complete information given to you in the conversation. Also, be sure to tell the doctor if the instructions will not work for you, for example, if you are unable to swallow pills.

He or she will also likely ask you if you have any questions. Even if you don’t, this is a good time to restate what you think you heard. For example, I said, “So, it looks like I just have a bad cold, which you think is caused by a virus, which is the reason I don’t need any antibiotics. And you said that if I don’t get better in another week, or if I get worse, then that is the sign that I should come back? And in the meantime, I should stay home from work, or is it okay to go back?” Of course, you should also ask any questions that you have.

Now your visit to the doctor is almost over. They will open the exam room door, which is your signal to leave. They will point down the hall in the direction you should walk, and they will go back to their station to update your file. You will stop at the check-out desk, where you will pick up any paperwork and finish paying if you have not done so already. At last, you are ready to go home and get well!

*These instructions vary somewhat for hospitals, as there is the possibility of either being seen and sent home, or being admitted for continued observation and care. It is only meant to be information about how things are typically done in the U.S., and should not be seen as medical or legal advice.

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