My first Singaporean ER experience…

Let me start with…I’m fine, Ravi’s fine, Elanor’s fine.

If you’ve been unfortunate enough to have been following my twitter/fb feed you know I’ve been suffering gastrointestinal distress since Wednesday.  When I couldn’t go to bed on Friday going into Saturday  because I couldn’t leave the bathroom long enough and I was starting to show signs of dehydration, I made the call around 4am to just go to the ER as I didn’t think a regular clinic would have necessarily have the stuff to rehydrate me (and waiting an extra 5 hours would make me that much more exhausted/sick/dehydrated).

I went to Mount Elizabeth Hospital, one of the private hospitals close by.  When I took E to the pediatrician, we went to a public clinic and while it was okay, I wanted to see if the private hospitals were closer to the standard of care from Boston.

In many ways, it was a standard medical experience.  Short version of why you’re here, are you allergic to any meds, temperature and blood pressure.  Ward with four beds and the curtains between them.  Bed with rails, pillow covered in plastic under the pillow case.  I got two liters of fluid via iv, was given meds and sent home.

But it many ways it was a radically different experience.

As you sign in, you have to tell them how you’re going to pay–as in cash, nets (debit card) or credit card.  Rates are posted clearly by the check in counter on a sliding scale depending on what time of day it is.  Overnight is most expensive at $120S ($85 USD).  Locals and permanent residents go to the public hospitals and their care is subsidized.  In our case, we have private insurance, but we pay for our care up front and then get reimbursed.

Some of the differences between the hospitals I’m used to in Boston and Mount Elizabeth might be the same sort of differences between Boston hospitals and more rural American hospitals.  After all, most hospitals aren’t affialiated with major medical schools or the recipients of multi-million dollar studies. But that is the standard of care I’m used to.

In many ways, the experience in Singapore was far more straightforward.  By luck, there wasn’t anyone there, so I didn’t have to wait several hours just to be seen.  I told them my symptoms and they treated me for the most likely reason for them.  This was a pretty radical difference from the last time I was seen for acute gastroenteritis in Boston, where I not only was given meds and fluids but had abdominable imaging and was in the hospital for close to 20 hours. There was nothing on the tubing of my IV to beep annoyingly and to alarm when the bag was close to being empty–a nurse just visually checked it every once and a while.

But part of me (the paranoid American part?) wonders if this really is a good thing…I wonder what would happen in a case like Elanor at a week old…where someone is close to death. I’m sure it wasn’t, but the hospital seemed fairly dead and the two other patients who came in during the two hours I was there were also briskly treated and sent home.  Without the more thorough testing, how much slips past them and becomes more serious?  But inversely, isn’t one of the biggest issues in the US exactly that–ridiculously staggering overhead for testing and such just to “rule stuff out”?

The other glaring difference was that no one asked me about medications I was currently taking or about medical conditions.  As it turns out, the antibiotic I was given is most likely contraindicated for me as I have a history with depression…which I only learned after googling it.  I was just given the meds (unlike the US where you have to leave the dr and go to a pharmacy, dr’s offices and hospitals have in house pharmacies–most likely because the country has super strict laws about the dispensation of medication–but it’s also a huge time saver) and sent home without the sort of fact sheets that I’ve always gotten at home (list the medication, describe possible side effects, etc).

What I’ve learned is that you really have to self-advocate.  The doc seemed (and this is just from reading body language) a little unconvinced as to the necessity of fluids, but hey-I’m paying so whatever.  I also could have chosen to check myself in and wait to see a specialist in the morning if I hadn’t wanted to go home with the antibiotic to wait and see how things went over the next few days.

I think it’s good that my first few experiences with doctors here (Elanor’s diaper rash, my gastroenteritis) were for fairly mild things because it’s been a learning experience.   I know next time to come prepared with a list of medications, past medical history and to google any medications myself.  If I think more should be examined, I know to push for it.

To be clear, there’s nothing WRONG with the medical treatment we’ve received here.  The offices are clean, if spartan.  Everyone washed their hands/wore gloves, etc.  I saw the equipment taken out of sterile packaging.  I was impressed when I was successfully IV’d on the first try (especially as they weren’t using a finer gauge needle).  It was fast-I was in and out in under 2 hours–totally unheard of in Boston, where I considered a 4-5 hour visit to be super short.  The total bill was $230S ($164 USD) including medication, which I’ll be reimbursed for, when my co-pay for just the ER visit in the US was $100 (with what is considered a very good insurance play) and then I would have had co-pays on the medications…probably ending up spending about the same amount of money out of pocket without reimbursement (and it would have been a fragment of the much larger bill my insurance company would have paid).  Most importantly, I’m feeling better if not fully normal 36 hours later.

In the end, I think I’m perfectly comfortable with the docs here for the run of the mill stuff, but I am SUPER grateful that GNB’s health policy is a global one.  All of Elanor’s specialists in the US will continue to see her (and we’ll do her 2 year well baby check up in the US with her old pedi as well) and I know for sure that I will be FAR more comfortable with them as her primary medical team.  If she weren’t stable we wouldn’t have moved; but we are lucky that her check-ups can be part of our two yearly visits home.  I’m also comfortable because with all of Elanor’s conditions (and the fact that all of her docs had an opinion about everything–and they didn’t agree most of the time) I’m used to advocating and questioning in medical situations.  But if it were a more serious concern, I’d want to get on the first plane home to be taken care of by US docs.

For those of you who have received medical treatment outside the US–what was your experience like (especially if you’ve been treated in the US for comparison, but even if you haven’t–speak up!)?  Do you think that regardless, if you spend 30 years getting one standard of care, all others are naturally suspect?

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5 Responses to My first Singaporean ER experience…

  1. Lennart Augustsson says:

    Sounds like you had a better experience than my one encounter with US health care (Mt Auburn hospital in Cambridge) where I had to wait for hours and then being sent home with the advice of taking some Peptobismol.

  2. Jessica Augustsson says:

    I have had really good experiences in Sweden. Once I had a terrible anaphylactic reaction and the ambulance came and i was immediately given epinephrine and theophylline. We couldn’t determine what had caused my reaction, though, so when I was better, and could breathe normally again, they sent me home. But then again my throat began to swell and I had to go back. Lennart just drove me that time and they admitted me right away, and even though they had no empty beds, they went out ofbeir way to make a space for me in the day room and let lennart stay overnight with me.

    In total, it cost me around $20USD.

    I was with lennart at his emergency room visit above. He was told nothing during the whole time he was there…left completely alone with no information for several hours. I’ve had vastly better treatment at rural hospitals in Idaho. Maybe the equipment is less new, but bedside manner is vastly improved.

  3. Saffy says:

    I sense that care here in NZ is somewhere between those 2 experiences… and I’m pleased to say that whenever I’ve been overseas I’ve never had to visit another hospital.

    I read about your gastro experience in Boston with a little mouth-wide-open’ness going on. You wouldn’t get that imaging etc here as routine practice. (Keeping in mind that you’re not footing any kind of bill for the experience, either.) In saying that, if it was deemed necessary, you would.

    I freaked out about the lack of questioning about your medical history. OMG. And the drugs and potential interractions. Wowzer. Here you can’t sue for medical malpractice, we have a govt funded compensation board instead. But that’s appalling and would stir shockwaves here.

    Regarding E as a lil person. Now that care IS different in terms of she’d be put thru the works here too. Little people are triaged quickly to the appropriate pedi ER and if necessary (i.e. you live in the sticks) you’ll get quickly transferred to a tertiary facility.

    And 4 beds to a ward? Ick.

    Hope you’re feeling much, much better 🙂

  4. bookjunkie says:

    I am more put off my the abrupt high and mighty attitude of some doctors here. I gets me really fed up as we are often in distress ourselves dealing with a sick parent or relative.

    When I try advocating they seem annoyed, like I should just keep quiet and listen to them. That is another thing that really annoys me.

    The nurses on the other hand are very sweet, my own especially at Tan Tock Seng was with the caring nurses from the Philippines. (singapore is short of nurses so they have many nurses from the Phllippines and China)

    • Crystal says:

      Yeah the brusqueness is a huge turnoff. Sadly, our daughter had a lot of issues at birth and spent a month in the hospital. Afterward she saw more than 5 specialists for a while and everyone had an opinion about everything (this was in the US) so I had to do a lot of advocating for her early on and its thickened my skin to the point where I will flat out refuse a procedure and roadblock a doctor if I don’t think they’re being cautious enough.

      The thing that scares me most is that they don’t ask about what other medications you might be taking to check for drug interactions. How do people not die every day from that?

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