* yes, there should be FIVE sets of boots but Allen ignored my advice to get adequate rain gear...

Sunday, September 9, 2012

Seeing the G. P.

Irish streptococcus bacterium are made of stern stuff.  Undaunted by my tonsil-less state, they said a Hail Mary and went for it.  They really made a go of it and I got soooo sick.  Of course, it happened on a Friday and, of course, it happened right after Noah had this high fever/congestion/typical toddler plague sort of thing.  By the time I figured out that I didn't have toddler plague and that, in fact, you CAN get strep throat without tonsils (having not faced the issue in the 10 years they've been gone), it was Sunday.

You can see a doctor in Dublin on the weekend.  But, it's complicated, especially when you haven't navigated the health system before.  It would involve walking and trains and unknown wait times and a very feverish and miserable me.  Wikipedia was very reassuring on the issue, steadfastly citing that the antibiotics would only shave about 16 hours from the length of the illness.  My fever was under control.  I was miserable but not miserable enough to face the unknown when the Ringsend Primary Care Center (my educator roots showed- for the longest time I thought that meant it was a day care center for primary school aged children) would be open and easily reachable on Monday morning.

By Sunday night, I realized that the writer of the wikipedia article really underestimated the whole "lessening of severity of symptoms" thing that antibiotics offer the strep throat sufferer.

On Monday morning, Allen took on the socialized medicine system for me.  The children all got dropped off at school and he called the Primary Care Center to see if he could make an appointment.  We were prepared to be told I would have to wait a couple of days; go to Accident and Emergency; fill out reams of paperwork; generally come against a wall of bureaucracy.  In fact, I'm pretty sure the call lasted less than 5 minutes.  At the end of it, Allen had me registered with the GP (General Practitioner), a firm answer on the cost of the visit and how to pay (50 Euro, cash), and an appointment for less than an hour later.

When we got there I was ready for a cavernous waiting room and number system similar to what you might find in a DMV.  Allen came armed with government paperwork, ready to fill out the sheaf of forms US medical care has made standard.  Allen told the receptionist we were there and she showed us to a bank of 12 chairs (maybe less).  There was no clipboard, no forms, no taking of insurance or payment information, no nurse/gatekeepers.  Periodically a nice looking man would poke his head out the door and call someone into an office.  After about 10 minutes and 2 other people, the man called my name.  Imagine my surprise when the man was actually the GP.  He asked what was wrong, entered all the information into his computer himself, took my temperature, patted me on the hand and generally behaved in a manner that made you think he actually had the time to enjoy practicing medicine.  He was efficient but not rushed.  When we had to figure out what various medicines were called in the US and Ireland, it was ok.  The whole thing took about 10 minutes.  He gave me my prescriptions and took the 50 Euros and we were done.  I was tucked back in bed less than 2 hours from the time I left it.  If we had been covered under the Irish health care plan, Allen thinks that there still would have been a charge but it would have been much less.

Allen got the prescriptions filled at the pharmacy down the street without fuss in less than 5 minutes for about 15 Euro each.  One prescription was clarithomycin, which I now know as the hallucinogenic antibiotic.  It took me a while to figure out what was going on since I was also on codine but, at least if I haven't eaten for 4-5 days, it sends me on a wild ride.  Happily, once I started eating, (about 2 days later) it still makes me dizzy but at least I'm not wandering the strawberry fields.

I was in tremendous pain and the pain reliever discussion with the GP was interesting.  Codine is given without nearly the rigamorole in the US.  You can get migraine medications with small amounts (12 mg- maybe 15?) of codine over the counter although I think you do have to request it- it's not just out.  I was prescribed 60 tablets of tylenol with 30 mg of codine- known in the US as tylenol3.  This is the same thing I got for my c-sections and then I got 30 and needed them all.  With this infection, I used fewer than 10.  The GP clearly knew he was giving me more than I would need but that didn't seem to be a concern.  I get the impression you would never see the codine hoarding you might find in the US- saving a pill or two for a bad migraine or awful cramps.  When I told him that percocet is far too strong for me, he didn't know what that was and looked it up.  He was clearly surprised that you would ever give that as a routine prescription- even post-operatively- with the comment "That's far too strong for almost anyone."  In the US, I've had tylenol3, percocet, and vicodin all prescribed post-operatively and all treated as roughly the same.  From experience, percocet and vicodin are a world apart from tylenol- anything that makes Facebook too cognitively challenging is just too strong in my book.

Allen and I talked a bit about if I might have wound up less sick if I had been in the US; if the issue was the delay in antibiotics.  Upon further reflection, I don't really think it would have made that much difference.  My US doctor's office has walk-in hours only on weekends and only on Saturday morning and Sunday afternoon.  I didn't know I needed to go to the doctor until at least late Saturday afternoon- prior to that I thought I likely had the flu and there isn't much a doctor can do for that.  So, I would have gone to the walk-in clinic on Sunday afternoon and started antibiotics about 12 hours sooner.  But, along with the earlier antibiotics, there would have also been a lot of additional stress on my body.  You always wait for at least an hour in the waiting room for weekend walk-ins and often 2 or even 3 hours.  There is the phalanx of people I would have to pass through before even getting to the back- check in ladies, nurses, etc- each requiring me to repeat symptoms, etc even though I was quite contagious and speaking was quite painful.  I would have waited in an exam room for another 30 minutes to an hour (These are walk-in numbers, mind.  Weekday appointments are more efficient but much harder to get.)  There likely would have been a strep test, probably blood work and perhaps discussion of admission to the hospital. When I finally left, I would then likely have to wait another 30 minutes for my prescription to be filled. I would finally fall back into bed about 4-5 hours after I left it.  If I waited until Monday to try to get an appointment, I likely would have gotten a morning one with the severity of my symptoms but it would be a "work in" and probably result in an hour or more in waiting rooms and whatnot.  The phone call to get the appointment would have included 5-15 minutes of hold time - the appointment line is always swamped on Monday mornings.  Any of those things would have involved co-pays.  My US doctor is kind and compassionate and efficient as well but is always a little stressed and harried- clearly being asked to cram in more appointments than she really should.

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