Going to the doctor in the "Golden Era"?

[matei]

This might sound like a daft question, but how was something as simple as scheduling a doctor's appointment done? Was there an equivalent to the health insurance that most people have/don't have nowadays, or did you just pay whatever the doctor's fees were?

What about paying for operations?

Although I lived as a child in the US, I don't remember much. I do remember seeing our family GP, an elderly man who's surgery was actually in his house.

I can recall a shift in the '80s after our GP passed away, when we had to go to a new doctor in a medical centre, and the term "co-payment" started to appear.

I asked my father, however he doesn't remember (?!?!).

 

[Shangas]

I thought back in the old days, a doctor came to you? I remember my doc used to do house-calls. I'm not sure if he still does them, but when I was growing up, I distinctly remember him still carrying them out.

 

[matei]

I should've been a bit more specific - my experience wasn't exactly Golden Era, although my childhood GP certainly was! I was a little kid in the '70s and a teenager in the '80s.

 

[Jaguar66]

I remember back in the 60s, insurance was simple. It was either Blue Cross or Blue Shield (It might have even been Blue Cross/Blue Shield). You would get a bill from the Doctor or hospital, and they would pay 80% of the bill, you paid 20%, no matter what it was (it might have been 90/10). But doctors/hospital rates were cheap then. Relative to today. That was assuming you had this insurance, which many did not have. And that was it. Until 1965, when Medicare came into being. Medicare paid for all medical care for those 65 or older. But the problem most doctors complained about, was they had to do the billing for the patient to Medicare in order to get payment. This meant hiring secretaries Before that Drs/Hospitals just billed the patient. The patient sent the bill to BC/BS, and they did all the paperwork. It was simple. If you didn't have insurance coverage with BCBS, and couldn't pay the bills, I don't remember what would happen, but that did not seem to be a great problem

Managed care (PPOs/HMOs), and the resultant copays, and the incredibly complicated varying plans of today, did not start until around the Nixon administration (early 70s). Kaiser, the penultimate HMO, has been around in California for a long time. But they didn't always have a good reputation, this has changed over the years, in this complicated world of medical care.

 

[matei]

Interesting... thanks for that reply.

Based on some of that info I was able to look up Blue Cross/Blue Shield on the aul Wikipedia:
http://en.wikipedia.org/wiki/Blue_Cross_Blue_Shield_Association

It has been around for quite some time!

I wonder what people w/o said insurance did when they needed medical attention? Probably the same as today methinks...

 

[Gregg Axley]

They had stopped house calls when I was coming up (late 60's-early 70's).
However, I agree with Jaguar on this, things weren't as complicated.
I don't remember even a quarter of the staff in the office that you see today.
A couple of Dr's, a few nurses (for shots, cultures, etc), and a receptionist that might also do billing.
Many of the Dr's we went to had their wives do the billing, keeps someone from cheating them, plus if they hired staff this person was also in charge of them. Great method because the wife was looking out for her interest while the Dr went about doing what he was trained to do. I know 2 personally that used this method and it worked very well.
It's funny, we watch many tv shows from the 50's through the early 70's, and see the Dr make house calls. I know, it's a tv show, but it reflected the era.
Until Jaguar mentioned it, I didn't really recall but he's right...most of the time I'd hear the receptionist say
"we'll bill Blue Cross."

 

[LizzieMaine]

Before the days of common health insurance, doctors would work often be willing to work out private payment arrangements with patients, especially those known to be in difficult circumstances: during the Depression, it was not uncommon for small-town and rural physicians to accept payment in barter rather than cash.

It's important also to note that fees were much much lower than they are today, even when accounting for inflation. The cost of having a baby, including doctor fees and a ten-day stay in the hospital might run about $60, which even in 1930s dollars is far less than today.

 

[matei]

Fascinating, how things change! Thanks for the information.

Re. the ten-day stay in the hospital, I imagine back then that there wasn't such a rush to get the mother and child out the door? We recently had a child back in April, and my wife was sent home after 3 days... and that was considered a lot.

I guess the NHS is under pressure for beds etc.

 

[adouglasmhor]

Yes but the hospitals in the UK were cleaner then, not everyone had a phone so you couldn't phone for an ambulance if something goes wrong and the ambulances were not so well equipped. It's like comparing apples and orangutans.

 

[LizzieMaine]

One of the biggest differences between then and now is that there was a greater emphasis on home-based care. As noted earlier in the thread, house calls were common, and it was generally believed that a patient would be more comfortable recovering from illness in their own home than in a hospital. "Sick Rooms" were a common thing, and most women understood enough common-sense nursing procedure to care for a sick family member under the guidance of the family doctor. Childbirth was an exception -- it was believed important to err on the side of caution because of possible childbirth complications and infections, so mothers tended to be kept much longer than is the case today.

As also noted in the original post, many general practitioners operated out of their own homes -- with the office and examination room part of their regular residence rather than maintaining offices in a "Medical Arts Building" on a hospital campus. The whole idea of a "Hospital Campus" itself wasn't common -- most hospitals in the Era were simple, free-standing buildings integrated into a neighborhood, rather than sprawling complexes of structures on a big lot outside of town. Such complexes are far more expensive to build, maintain, and operate than the simpler facilities they replaced, and that drives up the costs.

 

[Shangas]

This may seem morbid but along with sick-rooms (most likely just the bedroom), I remember being told a long time ago, that some large houses also had dying rooms and that such em...facilities...also existed in some hospitals. They were rooms which were quiet and dark (it was meant to be relaxing and peaceful) where people who were terminally ill could live out their last days in comfort. A family friend's aunt told us of the existence of such places. She was a nurse in a country hospital back in the old days...

 

[Marla]

Dying rooms are mentioned in Erich Maria Remarque's All Quiet On The Western Front (1929). After being wounded in a WWI battle, the protagonist recuperates in a Catholic hospital. He shares a room with several other wounded soldiers, and all of them dread being sent to the dying room. When the nuns come to move one of them to the dying room, he becomes hysterical and violent because the move signifies their loss of faith in his recovery.

 

[LizzieMaine]

I think there was a much more matter-of-fact attitude toward death in the Era, to be honest. People die -- and ultimately there's nothing anyone can do to prevent that. It feels like a lot of the modern attitude toward medicine is to try and deny that truth. We might succeed in putting it off a bit with science and devices and heaping piles of money, but ultimately the Reaper wins and he always will.

Among animals, when the time comes, it's common to go off and find a dark, quiet place to die in peace. Why should humans be any different?

 

[sheeplady]

Some doctors and healthcare practitioners still will barter for services, but typically you need to have a relationship with them first and you need to know them pretty well. These are typically single practitioners, not ones that worked in a large facility, and are in control of their own books.

I think one of the major contributors to doctors moving to large facilties is the cost associated with practicing medicine.

I can understand why they no longer operate out of their homes. I witnessed a man try to break a glass window between the waiting room and the receptionist in a doctor's office. The doctor had denied him a script for a narcotic, so he got violent. I would not want that type of behavior in my home or people like that knowing where I (or my family) live.

 

[JimWagner]

I think there was a much more matter-of-fact attitude toward death in the Era, to be honest. People die -- and ultimately there's nothing anyone can do to prevent that. It feels like a lot of the modern attitude toward medicine is to try and deny that truth. We might succeed in putting it off a bit with science and devices and heaping piles of money, but ultimately the Reaper wins and he always will.

I've always felt that the combination of fear of dying coupled with the amount of money insurance companies are willing to fork over combine to make dying big business, with big business being the larger part.

Today we have to have Living Trusts to prevent big medicine from milking our dying for every dollar they can. Even then, unless your relatives are on top of things, aware of your wishes, and willing to face down the doctors, you're likely to get hooked up to life support anyway. I have first hand experience with that scenario from when my mother was terminally ill.

Finding a dark room somewhere is infinitely more desirable to me than ending my days as a lab experiment.

 

[hatophile]

Advances in medicine in the last 40 years have made it easier to save lives, and/or extend life. This situation has made it much harder for patients, doctors and families to accept death as a part of life. While no one questions heroic measures offered to a young, healthy accident victim, the prolonging of life of an aged infirm patient is indeed questionable, but many have come to expect it.

Additionally, in years past the family physician was usually a part of the community and well-acquainted with
the patients and their families, so communication was much easier. Now we have to deal with hospitalists, hospital ethics commities, JCHO, and hospital legal departments to negotiate reasonable end-of-life care.

I have much more I could add, but at the risk of political debate will leave it at this:
There are a host of reasons end-of-life care is so much more complicated than the old days, when grandma or grandpa could pass their final days in care of a loving family. I don't think that's such a bad way to go.

 

[LizzieMaine]

I've always felt that the combination of fear of dying coupled with the amount of money insurance companies are willing to fork over combine to make dying big business, with big business being the larger part.

Yep. It's the biggest, bloodthirstiest racket on earth, and it's also the biggest sucker bet there is. No matter how much you spend, no matter how much you try, no matter how much the prospect terrifies you -- you are *always* going to lose in the end.

People cluck and tut these days about "the Victorian obsession with death," coffin photos, bracelets plaited from the hair of dead relatives, etc. etc. etc., but for all the Addamsesque extravagance of some of those things, I still say they had a far healthier attitude about the cycle of life than what's foisted on us today.

 

[C-dot]

It's interesting to read about experiences with American health care. In Canada and the UK, we have publicly funded health care. It's great, but our wait times for treatments, specialist appointments, and doctors are quite high, leading to the joke "If it doesn't kill you, it'll go away on it's own."

The historical aspect of Canadian health care is interesting. This comes from Wikipedia:

The early 20th century saw the first widespread calls for increased government involvement and the idea of a national health insurance system had considerable popularity. During the Great Depression calls for a public health system were widespread. Doctors who had long feared such an idea reconsidered hoping a government system could provide some stability as the depression had badly affected the medical community. However, governments had little money to enact the idea. In 1935, the United Farmers of Alberta passed a bill creating a provincial insurance program, but they lost office later that year and the Social Credit Party scrapped the plan due to the financial situation in the province. The next year a health insurance bill passed in British Columbia, but its implementation was halted over objections from doctors. William Lyon Mackenzie King promised to introduce such a scheme, but while he created the Department of Health he failed to introduce a national program.

It was not until 1946 that the first Canadian province introduced near universal health coverage. Saskatchewan had long suffered a shortage of doctors, leading to the creation of municipal doctor programs in the early twentieth century in which a town would subsidize a doctor to practice there. Soon after, groups of communities joined to open union hospitals under a similar model. There had thus been a long history of government involvement in Saskatchewan health care, and a significant section of it was already controlled and paid for by the government. In 1946, Tommy Douglas' Co-operative Commonwealth Federation government in Saskatchewan passed the Saskatchewan Hospitalization Act, which guaranteed free hospital care for much of the population. Douglas had hoped to provide universal health care, but the province did not have the money.

In 1950, Alberta created a program similar to Saskatchewan's. Alberta, however, created Medical Services (Alberta) Incorporated (MS(A)I) in 1948 to provide prepaid health services. This scheme eventually provided medical coverage to over 90% of the population.[31]

In 1957, the Diefenbaker federal government passed the Hospital Insurance and Diagnostic Services Act' to fund 50% of the cost of such programs for any provincial government that adopted them. The HIDS Act outlined five conditions: public administration, comprehensiveness, universality, portability, and accessibility. These remain the pillars of the Canada Health Act.

By 1961, all ten provinces had agreed to start HIDS Act programs.

Today, the government pays for about 70% of our health care. Private health care exists, of course, around which considerable controversy stands. The overwhelming majority supports our public system: The CBC held a vote a few years back for the Greatest Canadian, and the winner was Tommy Douglas (see above), "The Father of Medicare."

 

[MissLaurieMarie]

Hells yeah Tommy D! (Sorry, that's the Saskatchewan in me talking).
Back home in my small town things seem to be changing a lot. My sister was discussing on Facebook about how bad it is - you can't schedule something in advance unless it's a pre-op. Instead, you call the day of at 9am and hope someone can see you. If you're lucky, your medical issue can be dealt with by a nurse (such as a lady's physical). If you actually have to see a doctor, you'll have to call every day in the morning, hoping you get through. It's terrible to know that this is the way my grandparents - who were my age during the war - are now having to book their check-ups, prescription refills etc.

In Camrose, AB where I live, we have Primary Care Networks (PCNs) which seem to be a genius idea. It's a team of nurses, doctors and administration working together to create an emphasis on pre-care and prevention, rather than waiting until it's too late. Basically, they work together to provide care, helpd you find a family doctor, provide continuing support for chronic illnesses etc. Seems brilliant to me, anyway.

There was quite the emergency room crisis in Alberta this winter (which led to quite the political change in the province) and it honestly baffled me. Some people would wait in Edmonton emergency rooms for upwards of 8 hours, when I'm sure our ER in Camrose, just an hour south, was near empty. I actually mentioned this to our health minister during an interview and he said that he's personally encouraged doctors to send patients out to small cities to get emergency care, but usually they're resistant to the idea.

 

[hubbit]

As also noted in the original post, many general practitioners operated out of their own homes -- with the office and examination room part of their regular residence rather than maintaining offices in a "Medical Arts Building" on a hospital campus.

My grandfather was a chiropractor, and from the 1950s until the 1980s he, in fact, worked out of his house. Huge 1920s bungalow in Louisville, KY; his practice - which included exam rooms, cots for patient rest, an X-ray room, and a lab - was all on the ground floor. His film development lab for X-rays was in the basement next to my grandmother's laundry facilities. The family lived upstairs, two adults and five children.

In a different "golden age" touch, that house never had air conditioning. Summer cooling was done by means of strategically-opened windows and a huge exhaust fan in the wall on the stairway between the ground floor and the second. This, I am led to understand, was quite common in the era.