I have recently had the privilege of a personal investigation into the medical establishment in Singapore.

I hope not to bore you with these details, but I feel they merit a retelling, especially with consideration that the US is currently embroiled in discussions over the future of healthcare, knowing that Singapore is sometimes highlighted as an exemplary mixture of private and public care.  I will not choose to get into those politics at all, however, only to tell a little story.

So right after our trip to China (I don't actually think related), I noticed a swelling in my underarm.  It seemed to come up quite suddenly and was tender.  A perusal of WebMD suggested a sebaceous cyst, which may or may not go away on its own.  I gave it a good week before I decided it was only getting larger, and visited a doctor.

Now my insurance plan is actually private, but under the plan (that I don't entirely understand) it is just a $5 co-pay to visit a panel clinic.  There are a list of approved clinics that I can go to.  There are about 6 quite close to our home, and I chose on a Saturday to visit one.  The place that I went was pretty quiet, nobody in waiting area, but I checked it out.  I only needed to provide my insurance card and pay the $5, surprisingly did not need to fill out any paperwork, and was seen within about 5 minutes by the doctor.  His office looked pretty old, a little disorganized, but he was professional, asked what the problem was, had a look, agreed it was most likely a sebaceous cyst, but that it could be a lymph node (to which I'm thinking "that's why I came to the doctor, I thought you would know that part")... and suggested I visit a surgeon who could look at it and decide whether it needed to be removed.  I just agreed to do whatever he thought I should, and he filled out a referral.

The referral is necessary for insurance purposes, as that basically means when I visit the specialist, it will be covered (or covered at a better rate anyway).  The following Monday, I visited a surgeon at Singapore General Hospital.  He had a look, repeated the same, and advised that we try a course of antibiotics to see if it would go away on its own.  He also did not seem to indicate with full knowledge whether this might just be a lymph node.  He scheduled a follow up 2 weeks later to have another look.  I was required to pay out of pocket $80-something for the consultation, then of course I had to proceed to the pharmacy for a 30 minute wait.  I am then able to claim that $80 and will be reimbursed by insurance, minus a small copay again, $15 I believe.

And so I took the full week of antibiotics, and it all but went entirely away.  I canceled the follow up appointment a couple days prior, figuring it was gone and there was no reason to go pay another $80 for the doctor to agree (even if I'd get most of that $ back).

Unfortunately, the week after our trip to Siem Reap, I came down with a mild cold- and right exactly as that happened, my lump returned just as it came, suddenly and with irritation.  Once again, I gave it some time, figuring that had it been a swollen lymph node all along, it was only recurring with the cold, and would go away all its own.  The cold left me, but the lump remained, and I was forced to reschedule the follow-up appointment.  That visit was the Monday last week.  Once again, I was prescribed a course of antibiotics, but a surgery was scheduled to remove the cyst (the doctor was sure it was a cyst at this point) last Friday.  What that actually meant was that the doctor told me the surgery would be Friday morning, but then sent me down the hall, so that I could take a queue number (every single step of the way, there is a queue number and a waiting game), wait 30 minutes, and be seen by a nurse? who basically filled out paperwork in front of me, scheduling the actual appointment.  Now is a good time to point out that upon my first visit to the doctor as antibiotics were prescribed, I was asked about any allergies.  This was repeated by the nurse at this point, and she also gave some instructions about the day of surgery (like be there a full hour before the actual surgery).  She also told me what it would cost- about $1200 (yikes!).

After this wait, I proceeded to pay for my second visit to the doctor (reduced rate upon follow-up, just $60-something), then back to the pharmacy for more antibiotics (another 30 minute wait or so).

Between this follow-up and my surgery, I checked in with my insurance about coverage for the procedure.  It was not 100% clear to me, but what I could find seemed to indicate that 90% would be covered by the insurance.  I also noticed, though, that some other complications-- complete kidney failure, for instance, were covered at 0%.   This is why I wasn't sure the 10% that I found for my indication was what I would pay or what the insurance would pay.  I made a few phone calls and ensured 10% was my portion.  I'd hate to have a kidney fail...

Friday morning came and I got up nice and early to arrive a full hour before my surgery.  I came in, took a queue number and found a magazine to read.  After about 15 minutes my name was called.  I paid (in cash), signed a form or two, and was asked about any allergies.  Then I waited another few minutes before being called in.  There it was necessary to completely change clothes, putting on the hospital gown, getting the bracelet, everything.  I even had to take off my wedding ring and remove my contacts.  I was asked if I was allergic to any medication, then my blood pressure and temperature were taken, and I was seated for 5-10 minutes, before a second nurse arrived to escort me along my journey.

Her first question: "are you allergic to any medications?"

She walked me a few feet down the hall, where I changed from my sandals into approved slippers, and then entered a new waiting area.  About 5 minutes later, a nurse arrived.  You know what she asked me? Yes, you do.  She walked me a good ten feet down the hall-- to another waiting area.  5 minutes later, another nurse, but still the same question.  I informed her that in the previous 5 feet I had not developed a sudden allergy, to the best of my knowledge.

I was finally escorted into an operating room where I met the doctor.  He had another look at the cyst-- the antibiotics had once again reduced swelling, but he did not feel it was going away and wanted to put his degree and scalpel handiwork to use, so I signed some more paperwork, assured him and everyone in the room that if it turned out I was allergic to any of the medications they used, this was something I did not know beforehand, and then we finally got me on an operating table.

I was surprised at the whole thing, as I imagined it a very simple procedure, and nobody really explained what to expect, other than of course that it was local anesthetic and not general.  Everything else about it was full on surgery though.  They hooked me up to a blood pressure monitor, exposed my underarm and then covered every other bit of me, such that I had no idea what was going on during the surgery, except when the dr informed.  I only felt the first couple of shots, and afterward was unaware anything was being done to my arm.  The whole thing lasted about 10 minutes after the shots.   Cyst was excised (I got to see it, but I'll save you the description, other than to say it was bigger than I expected), stitches sewn, and I was on my way (back to the pharmacy, to wait in line, for another round of antibiotics).

So, it's one anectodal story, but I thought someone else might be interested.  It was annoying that dr. number 1 at the clinic was most useful for his ability to write a referral letter, not even a prescription for antibiotics.  The queues and waiting were annoying, and I'm sure you picked up that the allergy question was ridiculous.  I definitely do not like paying up front.  I don't know how that works out when it is a really serious bill.  But in the end, I did get quality care at not much cost to myself, so I will try not to complain too much.. or just enough to get out of doing dishes.