Next Friday marks the 73rd World Health Day, and now in the context of the epidemic of infectious viruses, this day is even more meaningful, as if to remind everyone that our life safety and physical health need to be guarded by all members of all human beings. In this issue, Chinese authors from Japan, Australia and Switzerland are invited to describe their daily stories of seeing doctors in foreign countries, share their real experiences, and introduce the convenience and inconvenience they have observed and experienced.

The process and experience of medical treatment vary from country to country, and there are problems large and small. Seemingly simple things have many facets, and the advantages and disadvantages of other countries cannot be judged by their own advantages or shortcomings, and each country needs to make trade-offs and improvements according to its own specific conditions. The ultimate goal is to enable people to achieve social equity and justice within affordable affordability while providing health care.

Medical experience in Australia: Talk about family doctors and health insurance

In all these years in Melbourne, the first contact with the family doctor was to vaccinate the child. Follow the appointment time and wait after registration at the front desk. After a while, the doctor came out of the consultation room to greet him. The doctor checks the vaccines that have been vaccinated in China and the vaccines required to be vaccinated in Australia at this age, and then indicates which ones need to be vaccinated, and then vaccinated by the nurse, and the nurse chatted with us very casually.

Another time, I saw a doctor because of digestive problems with my child. Telephone appointment in the morning, because it was a weekend, the front desk said that our doctor was not there, asked the doctor on duty if it was okay, we said no problem, so we arranged it for us at noon that day. When we arrived at the clinic, there were very few people, and before we could sit down after registration, the doctor in charge of us came out and took us into the consultation room.

We described the general situation, the doctor asked carefully, and pressed the abdomen again, and said: "It's okay, go home and drink some porridge temporarily, eat something light, and slowly resume eating when the spirit is better." Don't worry, the child will get better very quickly. I added, "Do you want to drink some electrolytes?" The doctor said, "It's okay, it's okay if you don't drink it." ”

Family doctors do not wear white coats to show cordial reception

General headaches, brain fever, do not prescribe medications

I noticed a small phenomenon, and the family doctor did not wear a white coat when he saw the consultation. Probably because Australia encourages easier and closer relationships between doctors and patients. Of course, doctors can still choose to wear a uniform if they feel they need a uniform to maintain a professional image or follow the norms of the medical profession.

GPs in Australia are family doctors or general practitioners, who usually provide initial diagnosis and treatment, including prescribing drugs and conducting initial examinations. But for small headaches and brain fever, doctors basically do not prescribe drugs. In some more severe cases, they refer patients to a hospital or specialist for further diagnosis and treatment. Examples include sudden severe or acute illness, severe infections, diseases requiring surgery or other specialized treatment, and complex treatment of long-term chronic diseases.

There are about 6000,<> general practitioner clinics in Australia and nearly <>,<> in Melbourne, providing basic medical services, including family medicine, paediatrics, gynaecology, elderly care, etc. GP clinics are usually located in community or urban centres, where patients can choose from the nearest place without long waiting and queuing, and patients can establish a long-term medical relationship with GPs.

There are two types of health insurance in Australia

In order to ease the burden on public hospitals, the government encourages the purchase of private insurance

Statutory Health Insurance: This is a public health insurance scheme provided by the government. Australian citizens, permanent residence visa holders or those who submit information to apply for permanent residence are eligible for public medical care. Statutory health insurance can help cover basic medical expenses, including medical visits, examinations and hospitalizations. However, it may not be possible to cover some additional medical expenses such as dental treatment, eye treatment, etc.

Private health insurance: This is medical insurance provided by a private insurance company that provides more comprehensive health care coverage. Private health insurance usually covers items not covered by statutory health insurance, such as dental, ophthalmic, physiotherapy and drug costs. Purchasing private health insurance can help access faster and more convenient health care, while also providing better hospital access and higher standards of care.

My family and friends around me have almost all purchased private medical insurance on the basis of enjoying Australian public health insurance. It is worth mentioning that in order to encourage individuals to purchase private insurance, so as to divert part of the medical needs to private hospitals and ease the burden on public hospitals, the government will give monthly subsidies according to the age, income, insurance plan and other factors of the insured to reduce the purchase cost.

Non-life-threatening examinations and surgeries

It may take weeks or months

Although Australia's healthcare system has many advantages and implements a universal health insurance scheme, there are still some areas that need to be improved and improved. One of the most commonly criticized is that certain diseases and examinations require longer waiting times in some hospitals.

When dealing with patient emergencies, public hospitals often rank patients according to severity, prioritizing treatment and surgery for emergency and severe patients, ensuring that they can receive appropriate medical care as soon as possible. Some tests and surgeries that are less severe or non-life-threatening may require weeks or months.

However, such cases cannot be generalized. Different hospitals and different doctors will have slightly different judgments on urgency. To reduce the waiting time for surgery, consider choosing a hospital with a shorter waiting time among several hospitals, or choosing a private hospital. In private hospitals, waiting times are usually shorter, but higher medical costs are to be paid.

Although the universal health insurance system implemented in Australia can ensure the popularization of basic medical services, for some high-end medical services and drugs, patients still need to pay for themselves or purchase private medical insurance, resulting in higher medical costs.

Although Australia's healthcare system focuses on the equitable distribution of medical resources, there is a shortage of medical resources in some areas and places with low population density.

Text/Li Mumu (currently living in Australia)

Hospitals of various sizes in Japan

What is the difference between a clinic and a clinic?

In Japan, it is not necessary to go to a major hospital to see a doctor, but often to find a hospital close to home. There are many highly specialized clinics around my home, such as otolaryngology clinics, internal medicine clinics specializing in gastric diseases, diabetes clinics, thyroid clinics, pediatric clinics, etc., as well as medium-sized general hospitals. Finding the right hospital is crucial, because if you encounter a hospital that is not specialized in the disease, it is difficult to delay treatment.

Seeing a doctor at a medium-sized hospital in Japan

What is the process?

Originally, I was quite confident in my body, but in early February, I started to feel dizzy due to overwork. The nearest hospital is Yamaguchi Hospital, which is a medium-sized hospital. Hospitals in Japan, regardless of size, are very clean, and some hospitals need to change slippers when entering the door. The Yamaguchi Hospital I went to was newly built two years ago and has internal medicine, ophthalmology, inpatient department, and emergency department. The first time I went to a hospital, I first went to the front desk to give my health insurance card to the staff, then took my temperature, and the staff handed me a consultation form, asked me to fill in the symptoms, when it started, whether there were underlying diseases, whether there were contraindications to taking medication, etc., and handed it to the staff, who put it in a folder and handed it to me, asking me to put the documents on the table in front of Room 2 - the internal medicine treatment room of this hospital has only three No. 3, No. 1 and No. 2.

Then the nurse immediately asked me to go in and measure my blood pressure, and I was shocked to know that I had high blood pressure for the first time in my life. The nurse immediately said: "Don't worry, the doctor will examine you immediately, you may need to hang the bottle." Then he led me to a "private room" completely enclosed by a curtain and asked me to lie down and rest. After a while, the doctor came into the curtain room to consult and auscultate with a stethoscope, and said to me: "Is it a lot of work pressure and overwork?" "Speaking of my heart.

The nurse who measured my blood pressure came in, and I saw that her badge said "Yoshinaga." She was very experienced in pricking my needle and giving me blood and drip (blood draw and drip were a needle point, and the nurse completed the connection of the two prescribed movements very smoothly). I suddenly felt that she laughed a little like Sayuri Yoshinaga. After typing the dots, Yoshinaga took a small bell and put it at the end of my bed, smiled and said, "If you have anything, press this." We'll come right over. ”

After dripping, the nurse took me to the doctor's office. Coincidentally, I met a doctor named Yamanaka who was proficient in Chinese medicine (i.e. proprietary Chinese medicine), he seemed to want to relieve my tension, asked me about my work and living habits like a family, and then he came to the treatment conclusion: overwork and excessive stress caused blood pressure to rise, and used Chinese medicine to adjust the autonomic nerves. Dr. Yamanaka seemed interested in Chinese culture, and when he learned that I was from China, he drew a map of China with a pencil brush and asked me to point out where my hometown was. Finally, give me a list to make an appointment for my next visit. This hospital has completely relaxed my spirit.

Japan implements a universal health insurance system, paying monthly premiums, and individuals only need to pay 30% of the medical expenses for medical treatment. After settling the cost of the medical treatment, the staff gave me a freshly prepared hospital treatment card with my name on it, which I must bring with me when I come to see a doctor in the future. Get your doctor's prescription and go to the pharmacy near the hospital to pick it up.

University affiliated hospitals in Japan and

A metropolitan hospital run by a local government

According to the Ministry of Health, Labour and Welfare, as of January 2021, there are 1 medical institutions in Japan. Hospitals in Japan are relatively evenly distributed, and there are large and small hospitals in each region, with different sizes and different divisions of business. Many universities have affiliated hospitals, such as the University of Tokyo Affiliated Hospital, Keio University Affiliated Hospital, Juntendo University Affiliated Hospital, etc., university hospitals are large-scale, high-end equipment, strong medical staff, and there is a saying in Japan that universities with affiliated hospitals are quite powerful. In addition, there are hospitals run by local governments, such as several Tokyo metropolitan hospitals, which are also large and have complete medical departments, but most metropolitan hospitals require patients to have a letter of introduction from other hospitals before accepting patients, which means that for diseases that are difficult to treat in small hospitals, doctors write a letter of introduction to patients and refer patients to appropriate large hospitals for treatment.

The aging society is also reflected in hospitals

Doctors and nurses are older

In the hospital, I saw that many elderly people came to see the doctor alone, they were on crutches, and they moved slowly, but the nurses were very attentive, and when they saw that there were elderly people who had difficulty walking, they immediately went over to help, or pushed wheelchairs for the elderly to sit. When the old man was sitting, they bent over and squatted on the ground to talk to the old man.

There is another medium-sized general hospital near my home, characterized by the older doctors and nurses. The grim reality of Japan's aging society is also reflected in the healthcare system. When doctors around the age of 70 treat patients, they often forget the name of the medicine and need to be reminded by the assistant next to them from time to time. They type very slowly, their hands are still shaky... There are also many nurses in their fifties and sixties. Many local hospitals in Japan still have a shortage of nurses.

Text/Huang Wenwei (currently living in Japan)

An Apple "tragedy": Swiss children see medical treatment

Friday night was supposed to be a quiet and relaxed atmosphere, when suddenly there was a scream from the kitchen, followed by a tearing cry: "I cut my hand!" "I heard the sound rushing into the kitchen, my little daughter's left thumb red and blood dripping on the floor. When she was cutting an apple, she accidentally cut her finger with a sharp blade because the apple rolled.

In Switzerland, children with fever or minor injuries generally do not go to the hospital. If you have a headache and brain fever, going to the doctor will also let the child go home to heal itself, and if the pain is small, there is usually a disinfectant spray and simple bandaging tools at home. But seeing the speed at which the blood was pouring out, the child's father immediately decided to go to the emergency room.

From downtown emergency to children's hospital emergency

How her daughter's emergency cuts were treated

We live on the outskirts of Bern and it only takes ten minutes by bus to the emergency department of the children's hospital in the city. After we simply disinfected it and wrapped it in gauze, Dad took her health insurance card and set off. When he arrived in the city, he suddenly thought that the children's hospital emergency department was notoriously long waiting, so he temporarily decided to go to the emergency clinic in the city center.

Once here, the wound can usually be treated in 5 to 10 minutes. Soon a doctor took care of the wound, quickly and carefully disinfected, observed the wound, bandaged it, and at the same time carefully questioned about the process of the injury. We thought it would be a wound that could be closed with sutures, but the doctor said that the child needed to go to the emergency room of the children's hospital for examination, because the wound was relatively deep and might not be just a simple suture but a surgical suture.

My little daughter is a very determined child, except for the first few minutes when she was injured and cried because of pain and fear, and she was brave and laughing and joking with her father. Another 5 minute bus ride to the children's hospital emergency department. The emergency rooms of Swiss hospitals don't have the tension of a movie drama, and Friday nights are even quieter. The uniforms of the nurses here are printed with a variety of cartoon motifs, and everyone wears expensive ultra-light sneakers. The hand surgeon on duty in the emergency department is a very fashionable young female doctor. She was dressed in a white robe, stepped on a pair of high-barreled combat boots, and carried an aluminum alloy toolbox, like a wounded warrior. Later we learned that this fashionable doctor was the winner of the beauty pageant of Miss Switzerland. She carefully examined the wound again to ask about the injury, and the child was left in the hospital awaiting surgery.

Because it was a weekend, and the injury was not an urgent operation, the waiting time was a bit long, and it took a full day for the child to be scheduled for surgery.

Physiotherapy and finger rehabilitation training were also provided after discharge

The whole treatment process pays attention to the child's psychological state

On the third day of discharge, the child went to the physiotherapy department of Children's Hospital for three months of physiotherapy and finger rehabilitation training. The hand rehabilitation therapist presents a model of the hand with bones, tendons, ligaments and nerves of the hand. She explained the injury to the child in detail, telling her that the left thumb was a common finger wound, nicknamed "avocado cut". The most common scene that happens is the action of throwing the blade to the core of the avocado while cutting it. Although the left thumb may seem like a less commonly used finger, it can affect hand grip strength after being injured, so it needs daily practice to regain function.

Throughout the treatment process, we observed that the doctors and nurses at the Children's Hospital are very good at chatting with children. They pay great attention to the child's psychological state during the diagnosis process. It can be seen that everyone has a set of words that make the child not afraid. One day later everyone saw my little daughter and said, "Ah, you're the little girl who cut the apple?" The doctor said you are great, that incision is beautiful! In addition to reassuring the children, they will also popularize medical knowledge at any time and encourage the children to think scientifically to restore their health. Finally, the child will be encouraged to say, "You are doing so well, do you want to become a doctor, nurse or therapist in the future?" ”

Because every resident of Switzerland has compulsory health insurance, the cost of this long and complicated treatment process is covered by health insurance. Although an apple sent her to the hospital, the whole process was not painful and difficult, the child not only did not have fear, but also learned a lot of medical and nursing knowledge, and improved the ability to avoid danger in daily life. It was a memorable experience for us and our daughter.

The reality is the number of pediatricians in Switzerland

Much less than actual demand

In Switzerland, children are registered with a paediatrician (clinic) at birth, and any medical needs are considered to be under the jurisdiction of a paediatrician until the age of 16. The number of pediatricians in Switzerland is far less than what is actually needed. Many new parents take a long time to find a pediatrician to register. And when the child is very young, if you move across state districts, you have to find a new pediatrician in your new place of residence, and many pediatric clinics are overcrowded so they only accept new patients in their own state, and moving across state is simply difficult for the child's parents. Even if you finally find a pediatrician after many hardships, it is not very easy to see a doctor. If your child is unwell, you need to call first to make an appointment. Because many patients make appointments, it is very difficult to make an appointment, and it is an impossible task during the high incidence of infectious diseases in winter. In the event of an emergency, parents can take their children directly to the emergency department of the children's hospital. But the emergency room is not very efficient, and you often have to wait for hours in the waiting area to see a doctor after entering the hospital. Maybe that's why everyone they see persuades everyone to join the medical profession.

Text: Shufen Jia (currently living in Switzerland)