efratti (![[info]](http://l-stat.livejournal.com/img/userinfo.gif){kind=small} efratti) wrote,@ 2008-06-21 23:17:00 |
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A Consumer's Review of Jerusalem's Urgent Medical Care Center
Intro
When sick this past January, I waxed, waned and pondered the meaning of living in a society with socialized medicine and employers that require sick notes from doctors. I can now add to this commentary as I spent some quality time this past weekend in an Urgent Care Clinic.
Spoiler alert: Despite feeling uncomfortably ill and distraught, it was a positive experience. In light of the US presidential elections this November, I hope Americans can have an intelligent debate on health care reform. While Israel's system has its own flaws, the Urgent Care Centers is one example of superior care.
Friday Afternoon, Not Too Exciting
Late June in a Mediterranean climate is pretty hot. This past week, it reached or exceeded 90 degrees every day in Jerusalem (one of the cooler Israeli micro-climates). I spent the day running errands, armed with a bottle of water, and most likely not drinking enough. I drank more when I came home, so in all likelihood I was not severely dehydrated. Although, it is definitely possible that I was somewhat dehydrated.
The delicate reader is advised to skip the following section and resume at the next one.
Feeling Sick on Friday Night
The moment I left the building of my Friday night dinner hosts, I instantly regretted that I did not ask them for one last drink before hitting the road. I was feeling only slightly thirsty when leaving their home, but I had a half-hour walk ahead of me. In the last 10 minutes of the journey, I began to feel nauseated. Once I reached home, the nauseated sensation realized itself into a bona fide episode. Fortunately, my festive shabbat clothes were unaffected. It was pretty gross, but I was feeling better afterwards.
But then, it started to get out of control. I went to bed promptly, b.c I was exhausted by the hour and the physical exertion involved in such activities. I woke up 15 minutes later for another episode that fortunately left my pajamas unharmed. While I could not admire my dinner and its ingredients in the toilet bowl this time, it was still largely food-based. Again, I returned to sleep, was already dozing, and within 10 minutes I was running back. This is when I realized that the distance between my bed and toilet was a "high alert, concrete" risk and that three episodes in under 45 minutes was objectively concerning: My body did not seem capable of soothing itself and spontaneously recovering.
In approximately two hours I had at least six distinct episodes. The last ones involved heaving and florescent-colored bile. Medical intervention definitely seemed warranted.
TEREM: The Urgent Care Medical Center
As indicated by my check-out form, I was admitted to TEREM, a Hebrew acronym for tipul refu'i mi'yadi, or Urgent Medical Care [Center], in the Romema neighborhood of Jerusalem at 3:55 am. I was accompanied by two loyal escorts, sister and roommate. The center recently relocated to a glamorous new office building across the street from its previous home. The building was well-marked on the outside as housing TEREM and inside the signage directing one to the clinic was beyond adequate. A good start.
When I arrived there was no one in the waiting room, and I was seen by the admitting doctor seconds after checking in at the front desk with my HMO card. My sister, one of my loyal escorts, claims that my horrible heaving down the hallway was audible to all and would have enabled me to beat out potential competition had there been any. Perhaps. Nonetheless, the zero-second wait was appreciated.
The admitting doctor asked me how I was doing, and I told him that I was about to die. He persisted with more specific questions in order to elicit a more precise description of my symptoms. After about three questions he diagnosed me as having a viral infection that has been "going around a lot lately" and the vomiting was causing me to be dehydrated. I asked the doctor his name, b.c he did not introduce himself. A nurse enters to takes my blood pressure and temperature. She does not introduce herself or state the results aloud.
The nurse brings me to the treatment room that adjoins the admitting room. It has three beds that can be separated by curtains, although there are no patients in any of the beds. When laying on the bed and a male enters with an I.V. bag and hook-up. I ask him if he is a nurse or doctor, secretly hoping he is a nurse based on the assumption that a nurse can insert an IV bag more skillfully. Alas, he is a doctor about to finish his studies in three months. I ask him his name, as he also failed to introduce himself, and realize that he an Arab. This realization prompts me to ask him in my state of near-death where he studied medicine. In my own medical bias, a doctor of any race or ethnicity can treat me as long as she or he studied at a Western medical school (or passed qualifying exams in a Western country). He learned "here" which means at the University Hospital in Ein Karem, Jerusalem. It then clicks that the admitting doctor and nurse were also Arab.
He inserts the IV expertly and within seconds I feel a warm rush in my right arm. I send one of my loyal escorts to inquire about anti-nausea medicine as the all-too-familiar sensation returns with predictable results. Such medicine is reportedly in my IV bag, and following this final episode there is no more florescent-colored bile outside of my body for the night. There was most certainly a sedative in the IV bag as well, b.c I fall asleep seconds after the episode.
At around 5 am the I.V. bag is drained and the drip in the tube is finished. The doctor returns to tell me that I can go home and that he will send me home with medicine. I cannot understand his verbal directions that accompany the medicine as they are too complex for my brain-dead state. However, since it is shabbat, I cannot take a cab home (as I best understand it), and I am not feeling strong enough to brace the hour-long walk home. So, I opt to roll over and sleep some more.
(Note: According to my understanding of Jewish law, one can do whatever is needed to get medical treatment on shabbat, i.e., call a cab, ride in it, pay the driver, bring along escorts who are coherent and can protect the sick person's safety and welfare. However, once the treatment is completed, the options are severely restricted. If a reader with rabbinic authority or more knowledge on this topic cares to comment, I would appreciate it.)
Check Out
At 5:30 am my loyal escorts announced to me that they are going to walk home. I nodded and fell back asleep. At 7:30 I rolled over again, this time feeling a bit better and realizing that it may be my only possible window to go home. I walked carrying my empty IV bag to the bathroom, passed an open window, and felt the current temperature to be low to mid-70s outside. If I fell back asleep, which was another highly viable alternative, I would wake up after walking home would no longer be a reasonable option. Armed with a 1.5 L bottle of water, I knew that if I didn't dash out right then, I might be committing myself to spending the entire day at the clinic.
Inspired by my epiphany and eager to be home, I requested from the nurse in the nurse's station to dislodge my IV. I went to the desk to check out and negotiating in my state of semi-coherence, I was understanding that I had a week to pay my bill of 66 NIS (~$19.60). I am not clear if this is a shabbat policy or standard payment policy. I did not go home with any medicine. I'm not sure if that's because I was without advocates at that point, or if the offer for medicine was only valid had I left 2.5 hours earlier.
I walked home on the shady side of the street, drank half of my bottle of water, and under an hour later (i.e., 8:30 am) I was asleep in my own bed. I slept the entire day until 6:00 pm with only brief interludes of awake-ness.
Conclusions and Reflections
Minor conclusions:
**There was good signage for the clinic, including its name written next to the appropriate elevator button.
**There is a concerted effort to have non-Jewish staff working in the clinics on Shabbat and holidays.
**I did not like the way the doctors and nurse did not introduce themselves, wear gloves (including while inserting the IV), or tell me my BP and temp.
The major conclusion:
The idea of an urgent care clinic is brilliant. The medical attention that I got was competent and efficient, warranted and legitimate, but not at hospital-care level. In the clinic setting, I was the patient in most need and shabbat notwithstanding, I would have been appropriately discharged in approximately an hour.
In a hospital, I would be heaving in a waiting room as they first treat victims of car crashes and heart attacks. Since I did not need intensive care (note: these clinics have x-ray services), there is no direct benefit by my being treated in that setting or need to be exposed to the germs of those patients. Instead, I benefited from being admitted and treated by doctors who are used to seeing the aggressive viruses, patients in need of stitches, and kids who stick stuff up their noses. The hospital-based doctor who treats car accident victims and others without limbs might think differently about my incessant vomiting than the clinic-based doctor.
Summary
The sorting mechanism created by having an urgent care center increases the quality and efficiency of patient care, clearly in the clinic and presumably in the hospitals, as well. I would assume that by keeping the likes of me out of the hospital, those presenting with severe medical needs benefit from increased the quality and efficiency of care, too.
Therefore, I will rate my TEREM experience as a big thumbs up.
Intro
When sick this past January, I waxed, waned and pondered the meaning of living in a society with socialized medicine and employers that require sick notes from doctors. I can now add to this commentary as I spent some quality time this past weekend in an Urgent Care Clinic.
Spoiler alert: Despite feeling uncomfortably ill and distraught, it was a positive experience. In light of the US presidential elections this November, I hope Americans can have an intelligent debate on health care reform. While Israel's system has its own flaws, the Urgent Care Centers is one example of superior care.
Friday Afternoon, Not Too Exciting
Late June in a Mediterranean climate is pretty hot. This past week, it reached or exceeded 90 degrees every day in Jerusalem (one of the cooler Israeli micro-climates). I spent the day running errands, armed with a bottle of water, and most likely not drinking enough. I drank more when I came home, so in all likelihood I was not severely dehydrated. Although, it is definitely possible that I was somewhat dehydrated.
The delicate reader is advised to skip the following section and resume at the next one.
Feeling Sick on Friday Night
The moment I left the building of my Friday night dinner hosts, I instantly regretted that I did not ask them for one last drink before hitting the road. I was feeling only slightly thirsty when leaving their home, but I had a half-hour walk ahead of me. In the last 10 minutes of the journey, I began to feel nauseated. Once I reached home, the nauseated sensation realized itself into a bona fide episode. Fortunately, my festive shabbat clothes were unaffected. It was pretty gross, but I was feeling better afterwards.
But then, it started to get out of control. I went to bed promptly, b.c I was exhausted by the hour and the physical exertion involved in such activities. I woke up 15 minutes later for another episode that fortunately left my pajamas unharmed. While I could not admire my dinner and its ingredients in the toilet bowl this time, it was still largely food-based. Again, I returned to sleep, was already dozing, and within 10 minutes I was running back. This is when I realized that the distance between my bed and toilet was a "high alert, concrete" risk and that three episodes in under 45 minutes was objectively concerning: My body did not seem capable of soothing itself and spontaneously recovering.
In approximately two hours I had at least six distinct episodes. The last ones involved heaving and florescent-colored bile. Medical intervention definitely seemed warranted.
TEREM: The Urgent Care Medical Center
As indicated by my check-out form, I was admitted to TEREM, a Hebrew acronym for tipul refu'i mi'yadi, or Urgent Medical Care [Center], in the Romema neighborhood of Jerusalem at 3:55 am. I was accompanied by two loyal escorts, sister and roommate. The center recently relocated to a glamorous new office building across the street from its previous home. The building was well-marked on the outside as housing TEREM and inside the signage directing one to the clinic was beyond adequate. A good start.
When I arrived there was no one in the waiting room, and I was seen by the admitting doctor seconds after checking in at the front desk with my HMO card. My sister, one of my loyal escorts, claims that my horrible heaving down the hallway was audible to all and would have enabled me to beat out potential competition had there been any. Perhaps. Nonetheless, the zero-second wait was appreciated.
The admitting doctor asked me how I was doing, and I told him that I was about to die. He persisted with more specific questions in order to elicit a more precise description of my symptoms. After about three questions he diagnosed me as having a viral infection that has been "going around a lot lately" and the vomiting was causing me to be dehydrated. I asked the doctor his name, b.c he did not introduce himself. A nurse enters to takes my blood pressure and temperature. She does not introduce herself or state the results aloud.
The nurse brings me to the treatment room that adjoins the admitting room. It has three beds that can be separated by curtains, although there are no patients in any of the beds. When laying on the bed and a male enters with an I.V. bag and hook-up. I ask him if he is a nurse or doctor, secretly hoping he is a nurse based on the assumption that a nurse can insert an IV bag more skillfully. Alas, he is a doctor about to finish his studies in three months. I ask him his name, as he also failed to introduce himself, and realize that he an Arab. This realization prompts me to ask him in my state of near-death where he studied medicine. In my own medical bias, a doctor of any race or ethnicity can treat me as long as she or he studied at a Western medical school (or passed qualifying exams in a Western country). He learned "here" which means at the University Hospital in Ein Karem, Jerusalem. It then clicks that the admitting doctor and nurse were also Arab.
He inserts the IV expertly and within seconds I feel a warm rush in my right arm. I send one of my loyal escorts to inquire about anti-nausea medicine as the all-too-familiar sensation returns with predictable results. Such medicine is reportedly in my IV bag, and following this final episode there is no more florescent-colored bile outside of my body for the night. There was most certainly a sedative in the IV bag as well, b.c I fall asleep seconds after the episode.
At around 5 am the I.V. bag is drained and the drip in the tube is finished. The doctor returns to tell me that I can go home and that he will send me home with medicine. I cannot understand his verbal directions that accompany the medicine as they are too complex for my brain-dead state. However, since it is shabbat, I cannot take a cab home (as I best understand it), and I am not feeling strong enough to brace the hour-long walk home. So, I opt to roll over and sleep some more.
(Note: According to my understanding of Jewish law, one can do whatever is needed to get medical treatment on shabbat, i.e., call a cab, ride in it, pay the driver, bring along escorts who are coherent and can protect the sick person's safety and welfare. However, once the treatment is completed, the options are severely restricted. If a reader with rabbinic authority or more knowledge on this topic cares to comment, I would appreciate it.)
Check Out
At 5:30 am my loyal escorts announced to me that they are going to walk home. I nodded and fell back asleep. At 7:30 I rolled over again, this time feeling a bit better and realizing that it may be my only possible window to go home. I walked carrying my empty IV bag to the bathroom, passed an open window, and felt the current temperature to be low to mid-70s outside. If I fell back asleep, which was another highly viable alternative, I would wake up after walking home would no longer be a reasonable option. Armed with a 1.5 L bottle of water, I knew that if I didn't dash out right then, I might be committing myself to spending the entire day at the clinic.
Inspired by my epiphany and eager to be home, I requested from the nurse in the nurse's station to dislodge my IV. I went to the desk to check out and negotiating in my state of semi-coherence, I was understanding that I had a week to pay my bill of 66 NIS (~$19.60). I am not clear if this is a shabbat policy or standard payment policy. I did not go home with any medicine. I'm not sure if that's because I was without advocates at that point, or if the offer for medicine was only valid had I left 2.5 hours earlier.
I walked home on the shady side of the street, drank half of my bottle of water, and under an hour later (i.e., 8:30 am) I was asleep in my own bed. I slept the entire day until 6:00 pm with only brief interludes of awake-ness.
Conclusions and Reflections
Minor conclusions:
**There was good signage for the clinic, including its name written next to the appropriate elevator button.
**There is a concerted effort to have non-Jewish staff working in the clinics on Shabbat and holidays.
**I did not like the way the doctors and nurse did not introduce themselves, wear gloves (including while inserting the IV), or tell me my BP and temp.
The major conclusion:
The idea of an urgent care clinic is brilliant. The medical attention that I got was competent and efficient, warranted and legitimate, but not at hospital-care level. In the clinic setting, I was the patient in most need and shabbat notwithstanding, I would have been appropriately discharged in approximately an hour.
In a hospital, I would be heaving in a waiting room as they first treat victims of car crashes and heart attacks. Since I did not need intensive care (note: these clinics have x-ray services), there is no direct benefit by my being treated in that setting or need to be exposed to the germs of those patients. Instead, I benefited from being admitted and treated by doctors who are used to seeing the aggressive viruses, patients in need of stitches, and kids who stick stuff up their noses. The hospital-based doctor who treats car accident victims and others without limbs might think differently about my incessant vomiting than the clinic-based doctor.
Summary
The sorting mechanism created by having an urgent care center increases the quality and efficiency of patient care, clearly in the clinic and presumably in the hospitals, as well. I would assume that by keeping the likes of me out of the hospital, those presenting with severe medical needs benefit from increased the quality and efficiency of care, too.
Therefore, I will rate my TEREM experience as a big thumbs up.
