The concept of health insurance in the US

I’m now back in Sweden after an amazing three weeks in Guam and currently am suffering from a severe Guam hangover. From sunny tropical weather to darkness and snow on my face for the next couple of months, yes there is a difference. Ah well, at least winter is kinda pretty and Christmas is just around the corner.

During my time working as “Dr. Sam” at the clinics and hospitals in Guam, I got to experience what is really alien to most of us here in Europe, which is the novelty of health insurance.

It’s true. All treatments are based on the insurance of the individual.

Let me explain it a bit more. Before going to a doctor, to be sure that the insurance will cover it, you need to apply for what you will be going to the doctor for. Because of this, some people are forced to wait, which sometimes leads to the worsening of their condition. Sometimes, it gets too late. This is mainly the case of patients who cannot pay for it first, or those who don’t want to risk the ability of not getting reimbursed by their insurance.

Secondly, there are different types of insurances. Depending on the type of insurance you have, doctors will treat you differently. Most health insurances are costly and privately owned, but some patients get free health insurance from the government as they are earning below a certain amount. Because of this, some greedy doctors (I’ve heard) do not prioritise these patients, as they barely will get money from them from their health insurance. In contrast to the patients with expensive health insurances, they will profit a lot from them.

To those who do not receive free health insurance and cannot afford the privately owned one, they’re in trouble. Going to a doctor then becomes very expensive, and a trip to the emergency room alone would cost several thousands of dollars. I wish I was exaggerating. Even the medicines are expensive.

For example, during my time in the US I managed to get an external otitis, aka swimmer’s ear. For this I needed anti-bacterial ear drops for. I got a prescription from my uncle, went to a pharmacy, and got my ear drops for $57.60. This is about 550kr. In comparison, I had a surgery in my arm in Stockholm in May, and that cost 350kr. Crazy isn’t it. I guess in this way, in one way or another, it is good to be home.

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Hafa adai from orthopedics in Guam, USA!

“Tito (uncle), that man has a limp on his left foot, what do you think is the possible cause?”

And so starts our lecture over lunch at the Hilton hotel, about different causes of asymmetrical limb lengths, ending with the classification of the different types of scoliosis and how to treat it.

Right now, I’m in the middle of the Pacific Ocean on a tropical island called Guam, which is a territory of the United States. (I know you were wondering where Guam is). I’m here for a three-week external orthopaedic placement with my granduncle-in-law, who is the local orthopedic surgeon in the region. I’m currently staying with him and my grandaunt (my grandmother’s youngest sister) at their house and am following my granduncle whenever he goes to work. It’s basically a mixture of vacation with work which I like to call, workcation. There is no better kind.

Since I was younger, I’ve grown up knowing of the many great things my granduncle has achieved throughout his career. I cannot even begin to describe how honoured and fortunate I feel to now be a part of it as his pupil. The generations of doctors in my medical family are now meeting. From breakfast lectures and handouts to clinic and surgeries, and finally ending the day with yet another dinner lecture. Everyday here in Guam has been countless learning opportunities in orthopaedics, and no time has gone to waste. Even the short car drives.

So you may be asking, how am I liking it so far? Well, I’m loving every bit of it, and somehow studying actually became fun now. I’m getting more and more tanned, bigger (no student diet here no) but definitely learning. I often reflect on how I ended up to be so fortunate with such amazing opportunities in life, but all I can do is be grateful.

This week I will be with Dr. Landström (yes, he is Swedish – what are the chances!) the local hand surgeon of the island, to have a greater diversity of cases within orthopaedics. Hand surgery cases that is. Tomorrow, I’ll be seeing my first hand surgery with him, and I better be on top with my anatomy. Like my granduncle, he is a very well-respected and experienced doctor too, who even has worked in Afghanistan. So to be on his good side, I better get back to studying, my break is over.

Hafa adai (the local greeting here which is pronounced half-a-day) from Guam! I promise to be back to write more about medicine and life here on the island. Until next time! 🙂

Five years later, I’m finally getting operated on

Five years ago I had to give up one of my passions which is playing the violin. It was not only because I was moving to the UK, but also because of a chronic injury on my wrist/arm.

Throughout elementary school and gymnasium, those who knew me always associated me with the violin. I even had the nickname “Violin Sam.” I used to say that the violin was like an extension of my arm. It was a part of me.

I was 17 years old when I got my injury, originally diagnosed as a Repetitive Strain Injury. I couldn’t move my hand/arm for a month and was in so much pain. I was devastated. A part of me was gone all of a sudden. Nevertheless I still kept playing as much as I could, at least to finish the concerts as well as I could. On a positive note I was allowed to skip my Physics final exam because I lost the ability to write – and my grade was pretty much set anyway.

I learnt to live with the pain and occasionally visit doctors and physiotherapists. During my entire time in medical school, I have always used a computer to write my exams. I wanted to be a surgeon back in the day, but quickly ruled that out as I can’t do surgery if I get constant pain every time I use my arm. Goodbye surgeon dream, goodbye violin, goodbye writing and drawing. Oh well.

 

me with my violin from the royal college of music in stockholm

This photo was taken on the day I returned my violin to the Royal College of Music in Stockholm in 2011, a few months after my injury. This was one of the last times I played the violin.

Years passed, and during my first clinical placement at Manchester University, I spoke of my problems with one of the doctors who was my supervisor. Intrigued with my story, he suggested for me to revisit my problem and get examined once again. I followed his advice and went to a doctor.

The constant visits to doctors began. During the entire year I was in Preston, I was examined by various orthopaedic surgeons, underwent MRI, X-Ray, Neurophysiological tests you name it. They didn’t even finish examining me within a year. I was told they couldn’t find anything wrong. When I moved back home, I decided not to give up and continued my examinations here in Stockholm.

I was referred to see a hand surgeon who turned out to be an anatomy lecturer at Karolinska. Within the 30min that he met with me, he diagnosed me with an unusual condition called Radial Tunnel Syndrome. I will have a nerve decompression surgery at the end of April/May.

For an entire year in the UK if not longer, I had to undergo so many tests when the diagnosis could’ve been made within a few minutes.

In other words, I could’ve been okay by now.

NHS, after being both a medical student and a patient in your system, I don’t doubt the abilities of your doctors but rather the system itself. I agree with the headlines – NHS, it’s time for a reform.

I can’t wait to return to playing the violin once again! 🙂