Last night, I cut my left index finger while cutting red peppers. The details aren’t too important, but it should be noted that the injury was very similar to one I received in college so I had a pretty good understanding of how serious the wound was.
In any case, this situation is a good opportunity to explore the differences in how I would have dealt with this situation had I still lived in the US versus how I actually dealt with the situation while living in Denmark.
Here’s what I would have done had I lived in the US:
- Use a paper towel to apply pressure to the wound and keep the blood contained.
- Get hydrogen peroxide, gauze, medical tape, and Neosporin from the bathroom closet.
- Rinse the wound with water and then hydrogen peroxide.
- Apply Neosporin to the wound.
- Wrap the wound (and my finger) in gauze and use medical tape to keep the gauze sufficiently compressed.
- The next day, change the bandage and repeat steps 2-5.
- Monitor the wound’s status and, only if necessary, go to the doctor.
Here’s what I actually did (in Denmark)
- Use a paper towel to apply pressure to the wound and keep the blood contained.
- Get hydrogen peroxide, gauze, and medical tape from the bathroom closet (i got rid of my Neosporin, which was several years old, before moving to Denmark).
- Rinse the wound with water and then hydrogen peroxide.
- Wrap the wound (and my finger) in gauze and use medical tape to keep the gauze sufficiently compressed.
- The next day, change the bandage and repeat steps 2-4.
- Go to Matas, the closest thing to Walgreens that Denmark has, to get some more gauze and some Neosporin.
- After not finding Neosporin or anything like it, call what is basically a nurse hotline to ask for advice on dealing with the situation.
- As instructed by the nurse with whom I spoke, go to the nearest emergency room.
- Remove the bandage I had applied myself and have a nurse put on special fingertip-shaped gauze along with a nice compression sleeve that goes around my finger and wraps around my wrist to stay on securely.
- Receive a tetanus shot.
- Get sent home with some extra gauze and compression sleeves so that I can change the bandage in 2 days.
- (In the future, I plan on changing the bandage on Monday morning and then again a couple days later; if the wound has not improved significantly by then, go to my regular doctor.)
The two courses of treatment are quite different, and I think there are a few explanations for the difference:
- The healthcare systems and the marginal costs borne by individuals. In the US, the marginal cost of an emergency room visit is almost always greater than 0, whereas in Denmark there is no out-of-pocket expense.
- Wound care supplies are hard to find in Denmark. In the US, a person can buy gauze, medical tape, Neosporin, hydrogen peroxide, iodine rinse, etc. at Walgreens, CVS, Walmart, Target, other discount stores, and even most grocery stores. And many of these stores are open 24 hours a day. In Denmark, Matas is the closest thing to Walgreens or CVS, and their wound care selection is limited to gauze, medical tape, and hydrogen peroxide (which costs about $8 for a bottle that would cost about $1 in the US). Also, Matas closes at 6:00 pm and and is closed on Sundays. Bilka, the closest thing to a discount store, has band-aids and that’s about it. As far as I can tell, Neosporin doesn’t exist in Denmark.
- Greater cultural homogeneity and greater trust in experts and top-down authority. In Denmark, for many things there is a sense of, “That’s just what you do.” It seems like everyone uses the same type of garbage can, the same type of dish towel, the same type of scrubbing brush to wash dishes…the list goes on. And since things often seem to work out for people, there’s not much of a reason to change things. The same dynamics seems to be at play for the provision of public goods, including healthcare. Taxes are very high (and getting higher), and most people seem to think they are worth it. The perception is that the system is the system and it seems to work just fine so that’s the way it goes.
So which approach is best? I like being able to do my own triage in the event of an injury like this one, and I don’t like not being able to have adequate supplies on hand to do so. Then again, I also appreciate having a professional apply wound dressing and hey, free tetanus shot!
This is a borderline case and had I not suffered from a very similar injury about 10 years ago (in which case I did go to the emergency room), I would probably have gone to the ER in my counterfactual US scenario. But at least I would have had the option of treating myself in the US. And isn’t self-provided care (assuming it is carried out competently) the best and cheapest course of action?
