What It’s Like When You’re an American Using Britain’s NHS (I)
美国人在英国如何看病（上）
文/吉姆·爱德华兹
译/葛玉芳
审订/文军
By Jim Edwards
I’ve spent half my life in the US and half of it in the UK, so I’m used to both countries’ healthcare systems. I recently returned to London after 20 years in America, and after a few doctors’ appointments I’ve come to see the NHS through American eyes.
这么多年，我一半时间在美国，一半时间在英国，因此对两国的医疗体系都很熟悉。在美国待了20年后，最近我回到了伦敦。体验了几次预约看病后，我可以从美国人的视角说说英国的医疗服务。
The National Health Service is, as all Americans know and fear, a completely public “socialized medicine” system. It’s dramatically different from the US’s patchwork system of private providers and insurance companies.
美国人尽皆知且深感惶恐的一点就是，英国国民医疗服务（以下简称NHS）是一个完全公共的“社会化医疗”系统。美国则完全不同，其医疗系统是由私立医疗服务机构和保险公司拼凑而成。
I’ve now used both systems for about two decades each, so I feel I have a pretty good handle on the main contrasts.
两种医疗体系我各使用了将近20年，因此很清楚两者之间的明显差异。
“This Rolls Royce isn’t moving fast enough!”
“这辆劳斯莱斯跑得不够快！”
The context here is that the NHS just released its most recent stats on accident and emergency room waiting times. The headline number is that 84% of patients are seen within four hours. In the UK, this is regarded as a huge failure—the standard the NHS is supposed to meet is 95% of patients in four hours. The UK media went into a fury about it, and some hospitals have begun postponing and rescheduling some non-emergency procedures in order to get those waiting times down. In the US, having sat in many an ER waiting room for hours at a stretch, the idea of a hospital seeing nearly 9 out of 10 patients in four hours would be regarded as a miracle. Bear in mind that within that four-hour period the NHS doctors are triaging[1] patients: If you get hit by a bus, you’re going to see someone instantly. If you broke a finger because you fell over while drunk at the pub, you’re probably going to wait at the back of the line. It’s not like people are literally bleeding to death while they wait for attention (although the British media loves it when it finds individual cases where that has happened).
这里说的是NHS刚刚发布了急诊室等候时间最新数据，总体数据显示，84%的病人能在4小时内得到治疗。这在英国人看来是一个巨大的失败——NHS制定的标准是95%的急诊病人在4小时内看上病。英国媒体对此怒不可遏，一些医院于是开始将一些不紧急的诊疗推迟或改期以减少就诊等待时间。在美国，我有过多次在急诊候诊室一连等待好几个小时的经历，听到有医院在4小时内为十之八九的病人诊治，简直像听到了奇迹。别忘了在那4个小时里，NHS的医生还要对患者进行鉴别分类：你如果是被汽车撞了，能够立即得到诊治；而要是你在酒吧因为醉酒跌倒而摔断了手指，那可能只能排在后面了。这并不是说病人在候诊时真的会流血致死（尽管英国媒体总是热衷于报道这样的个案）。
[1] 源自triage：患者鉴别分类；治疗类选法〔根据紧迫性和救活的可能性等在战场上决定哪些人优先治疗的方法〕。
So my overall impression is that currently, the Brits’ complaints that the NHS isn’t hitting that 95% mark is akin to saying, “This Rolls Royce isn’t moving fast enough!”
所以，我的总体印象是，英国人抱怨NHS没有达成95%这个标准，就类似于有人说“这辆劳斯莱斯跑得不够快！”
Show up when you’re told to—or else.
规定时间就医——不然另约。
The first major difference from the patient’s point of view is what happens when you call your doctor for a routine appointment. My specific health issue was that I thought I was going slightly deaf, and wanted it checked out. I’m a dual US/UK citizen, so I qualify for NHS treatment. Here’s what happened to me.
从病人的角度看，两种系统的最大差异首先就体现在电话约诊的流程上。以我为例，我之所以想看病是感觉耳朵有点听不清，想检查一下。我有美国、英国双重国籍，所以有资格获得NHS的治疗。以下是我的亲身经历：
In America, you call your doctor and request an appointment when it’s convenient for you. They might ask you what’s wrong with you, presumably to make sure it’s not something that requires immediate treatment. But basically, it’s first come, first served, regardless of how important it is. Usually, you can pick an appointment time that’s convenient for you if it is not an emergency.
在美国，你打电话给医生，并根据自己方便的时间与医生预约。对方可能会问你哪里不舒服，想必是为了确认是否需要立即治疗。但总的来说，无论病情如何，还是遵循“先约诊先治疗”的原则。通常，只要不是紧急状况，你都可以约在自己方便的时间去看病。
In the UK, I was given an appointment whether I liked it or not. I called and leave a message. Within an hour or two a nurse practitioner called me back and asked me a few questions about my problem over the phone. Then they said: Come in at 9am on Thursday. There was no choice over appointment times—the assumption is that if you’re ill, you’re going to come to the doctor when they say.
在英国，预约就诊时间由诊所指定，患者不能随意选择。我打电话并留了言。一两个小时之内，一位执业护士回电，在电话里就我的病情问了几个问题。然后对方说：周四早上9点过来。预约时间没有选择的余地——他们的假设是如果你病了，就会按医生给定的时间去看病。
At first I found this jarring. In America, I get to choose when I see the doctor! In Britain, I better show up when I’m told. But the appointment came quickly, as the local health authority in London has targets it needs to meet. Ultimately, I saw the logic of it: This is a public health system. It needs to manage its costs and services. If you’re really sick, you’ll show up. If you only want to show up when it’s convenient for your schedule, then how sick are you, really?
一开始我很震惊。在美国，什么时间去看病由我自己选择！在英国我却必须在指定的时间看病。但是很快就安排我就诊了，因为伦敦当地的卫生部门有其需要完成的诊疗目标。最终，我明白了其中的逻辑：这是一个公共医疗系统，其成本和服务都需要管理。如果你真的病了，就会及时就诊。如果只想在自己方便的时间去看医生，那你大概病得没那么重吧？
（译者单位：北京航空航天大学外国语学院）
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