Answer: "Hospital" and "Surgery" in American/British English

[chomiji]

debirlfan asked us "What are the rules for American versus British usage for 'hospital' and 'surgery'?

It's true that British usage on these common medical terms differs from what's encountered in the United States. We'll take a closer look at how these words work.

Comments

[sg_wonderland]

For one American view of the 'clinic', I tend to think of that more as a place where one would see any one of a number of doctors or maybe just a nurse. Most clinics come with a rotating staff of doctors, especially rural clinics. You might also see a nurse who can administer some shots, but could not write a prescription for, say, antibiotics; that would have to entail a doctor's examination.

My personal doctor has a physician's assistant who works in his office. She can do exams and write prescriptions. (Although technically, they are done on computer and whisked virtually to the drugstore/pharmacy. We don't have chemist's here in the States.)

A specialist (cardiologist, gynecologist, etc.) might be at the clinic one day every week or two weeks depending on the need. But I doubt if you would actually see a surgeon there; most of those visits would be in the surgeon's office or, more likely, in a hospital setting. My personal physician is on staff at a local hospital so if I were ill enough to require hospitalization, he would send me to this hospital because he would be in charge of my care.

[chomiji]

Yes, that's the usual U.S. definition of a clinic; see my response to pepper_field.

From the U.S viewpoint, the U.K. use of "surgery" to mean the facility in which a doctor provides an examination is distinctive and can be startling.

Doctors in the U.S. who perform operations of some sort typically have an office facility in which they provide examinations and perhaps a few other services, as well as "hospital privileges" at one or more hospitals or other larger medical facilities. An obvious example is the usual obstetrics/gynecology set up: you see the doctor(s) for your checkups in the office, but when you deliver the baby or need a D&C, you need to go to a larger facility such as a hospital, although you will be attended primarily by your own doctor(s) - the same one(s) who examined you in the office - while you are there.

The plurals in the preceding paragraph are because in more populous U.S. cities, group practices are very common.

[sg_wonderland]

Group practices are rare in my rural area; I'm guessing that's basically a city/country type of thing.

I really love it when folks offer this kind of advice for non-American writers trying to write American characters. For me, nothing takes me out of a story faster than hearing an American character using a British-ism or vice versa.

I spent a ton of time the other day (Downton Abbey fic) trying to discover if Carson would carry in the tea tray or if that would be some other servant. I still don't know definitively. I suppose I will actually have to watch an episode to find out. What a sacrifice!

[chomiji]

I think the group practice idea is definitely driven by population. When you have more people, they need more doctors, and when you have a certain number of doctors in similar areas of practice in close geographic proximity, it makes sense to practice as a group: you can split overhead costs (such as running the waiting room and ordering supplies) and back each other up, so no one has to be on call every weekend or evening.

>> What a sacrifice! <<

XD

There's also a marvelous book called Ager's Way to Easy Elegance (1980), written by an old-school butler, that covers a lot of the details of who used to do what. The book is aimed at encouraging modern folks without servants to take proper care of their clothes etc., but a lot of the author's actual experiences come out in his discussion of the various topics. (You would likely have to buy a used copy.)

[azure_chaos]

From the pov of England (and I say that because I don't know if it differs in Scotland).

Ah see there's another difference there. Now, being male I'm no expert on women's things but in general, you'd only see a obstetrics/Gynae if there was a problem otherwise you would be under your general practitioner (the GP that you see at the 'surgery' (or what the US apparently call a clinic), the woman would go to the hospital ante-natal clinic/maternity unit for scans and if there was a problem would see an obstetrician there, this would not be the doctor who sees them at the GP surgery. And often it'd be a community midwife that you plots your progress while pregnant at the GP surgery and not a GP (though I dunno if the GP is seen at certain milestones or only if there's a problem).

In my experience you only see a specialist (whether that's obstetrics, orthopaedics, surgeons, rheumatologists or oncologists) at a hospital and in order to see them your GP will have to refer you to them (and unless there's something urgent flagged then you'll usually have to wait at least a few weeks to get an appointment, though there is now a fast-track system in place for if it's suspected that you have cancer, though even that can still take a week) in my experience eye clinics are an exception, as you might be sent straight there by a GP or even an opthamologist after a standard eye test (they'd give you a letter and tell you to go straight there if there's something that requires immediate care).

Specialist doctors do have an office but they wouldn't usually see a patient there (it's more where they keep their stuff and go when they're not seeing patients, it might also be where their secretary is), patients are seen in clinics which are held in a group of consulting rooms in part of the hospital. Depending on the size of the hospital they may have a specific area dedicated to each specialty or they might have just one or two areas that will see a different specialist clinic using them on different days, eg. On Mondays and Fridays the consulting rooms were home to the Rheumatology clinic, Tuesdays and Thursdays were Orthopeadics and Wednesdays it was the neurology clinic.

[chomiji]

I'm learning some fascinating details here!

In the U.S., re women and OB/GYNs, the opposite is often true: their OB/GYN often acts as the GP, and the usual yearly checks (blood pressure and so on) are done when their yearly GYN exams are performed. In a subscription health maintenance organization (HMO) like Kaiser Permanente (one of the larger such options in our part of the country), a man's default doctor will typically be a GP, but a woman's will be an OB/GYN. (And a child's will be a pediatrician.)

Of course, there is no national health service (yet, anyway) in the United States. If you belong to an HMO, the same specialty referral practice you describe is followed: your "primary care physician" must write a referral (and it will usually be to another doctor in the HMO system, unless you have a very exotic problem). If you have "traditional" health insurance (sometimes referred to as "pay as you go"), you can freelance this, if you're willing to pay "out-of-pocket" to at least some extent. If you don't want to go back to your usual doctor for a referral, you can in theory call any doctor you wish. If the doctor is on your insurance plan, you pay a small flat fee (after your yearly "deductible"). Otherwise, you pay out of pocket and file with your plan for a refund. Most plans have a set rate at which they will reimburse you for these "out-of-network" services.

Most specialists here who are not part of HMOs (which have their own health service facilities, rather like small hospitals but without emergency rooms or major surgery suites) rent office space. Sometimes the entire building is devoted to medical services, but often, at least in major urban areas, the doctors will be in a building that also houses other professionals who need office space, including lawyers, real estate title services, and so on.

[azure_chaos]

I'm learning something too. :)

Yup, everyone here just goes to a GP, men, women & children as a first point of contact for everything. Often surgeries will also run things like an 'asthma clinic', which are often run by the practice/surgery's nurse. And, apparently it's usually a nurse at the GP's surgery who will do the women's smear tests once every 3 years (unless you're high risk); my sis-outlaw said it's rare that a GP will get involved in doing those but anything that's not routine is likely to go through the GP then referred to a specialist.

It would be wonderful to be able to choose which doctor's services you want to buy. In theory we were supposed to be getting this choice, but it's not happened as far as my experience. Of course, we do have the option of private health insurance, but that's another issue altogether lol.