HEALTHCARE INSIGHT
“When the elephants fight, only the grass gets trampled.”
That Cambodian proverb, which I first read years ago referring to the Viet Nam War, seems particularly apropos again today as I reflect on the furious debate over health care.
The big players, the politicians and large insurance companies, have employed their armies of spin masters and squadrons of public relations flacks and each seems to select only the facts that support their economic or political viewpoints.
CONFUSING: The big players – the politicians and large insurance companies – have employed their armies of healthcare spin masters and as a result, we are subject to half truths, outright deception and emotional bullying. It is almost impossible to discern the truth amid all the flying innuendo.
As a result, we are subject to half truths, outright deception and emotional bullying. It is almost impossible to discern the truth amid all the flying innuendo.
I have a unique viewpoint from which to watch this battle. Not only have I taken care of many patients who came from socialized countries, I actually have worked in one of the bastions of socialized medicine – France.
During my residency in Texas, I managed to talk my residency director into letting me do a two month sabbatical at Saint-Louis Hospital, the world’s oldest hospital devoted to dermatologic care. The experience gave me a unique insight into socialism, and socialized medicine.
Long Wait Times
First, the downside of socialized medicine.
Despite all the breezy proclamations from politicians about how well the Canadians like their current system of care, I have had patients from as far away as Calgary, Alberta fly down to Melbourne so that I might operate on their skin cancer. They would have waited nearly a year for treatment had they stayed in Canada.
I have a friend from Vancouver whose mother was recently operated on for a brain tumor. Although her tumor was benign, she was required to wait ten months for surgery to remove it. During the waiting period the tumor wrapped around her optic nerve.
It remains to be seen as to whether she will recover her vision completely.
Furthermore, I had a patient from Sweden who, while visiting his family in Melbourne, happened to show his brother, a patient of mine, a spot on his back. For four consecutive years he had shown the lesion to his primary doctor in Sweden, only to be reassured each time that it was a harmless mole.
When, during the last two annual visits, he asked for a referral to a dermatologist, he was refused. Since patients cannot self refer in the Swedish health care system, he was out of luck.
When he showed me the spot while accompanying his brother for his office visit last year, I saw a lesion that would have been recognized by any second year medical student as a superficial spreading melanoma, and a fairly advanced one at that.
Even though he could not pay me, we excised the melanoma in my operating suite that day, and directed his Swedish physicians on his subsequent care. Had we simply sent him back to Sweden untreated, I am convinced he would have waited too long before getting the care he so desperately needed.
Quality of Care
The British health system also has its problems. There was a recent article in magazine The Economist about the pitfalls of the National Health System. This particular article focused on the shoddy care delivered by physicians, many from Eastern Europe, who were flown in to work nights and weekend shifts in emergency rooms, after having worked full weekly shifts in their own countries.
What happens when one is treated by such sleep deprived, overworked physicians? One of my patients relates a chilling tale. Her sister in England developed sudden, severe eye pain and went to her local emergency facility to receive treatment.
She was given eye drops and told to go home and schedule an appointment with a specialist in the following week. Unfortunately, as any well trained physician would know, sudden onset of severe eye pain is a medical emergency and intervention is successful only when delivered in hours, not days. My patient’s sister is now completely blind.
Well Educated, Motivated
Beyond these chilling anecdotes, however, there lies another side of socialized medicine. In France, I saw numerous examples of medical care that was not just good, but excellent.
The doctors I worked with at Saint-Louis were extremely well educated, well motivated and tried just as hard as American doctors to treat their patients.
Each French citizen has access to a primary care doctor, who then refers to a specialist if the primary doctor deems it necessary. At the time I was there, there was also a second system of care, whereby those who were financially able often sought care outside the socialized system, with private doctors.
I met many of these primary doctors and there seemed to be no difference in the quality of these private doctors, but the private doctors seemed to offer their patients much quicker access.
The hospitals in France and also in other countries in Europe tend to offer excellent medical care, but in Spartan settings. The notion of a private room seems to be an American ideal that the rest of the Western world cannot afford.
In Spain, another country in which I have observed the medical system first hand, family members are not just encouraged, but expected to stay at the patient’s bedside and render the care that in the U.S. is delivered by trained nurse’s aides.
Emptying bedpans, bathing and feeding the infirm and severely ill all fall to the family members who are at the bedside night and day for the duration of the stay.
Considering the Options
There are many choices we will have to face in the upcoming months regarding how much we should spend on health care and how we should pay for it. We may have the best hospitals and doctors in the world, but it costs more than anywhere else.
As you, the patients, consider the options presented before you, I encourage you to find out the minute details of what you will be receiving for your dollars.
To end with another Asian proverb, “Be careful for what you ask, for you will surely get it.”
Dr. Larry Bishop is an affiliate of MIMA, located in Brevard County, Florida. He specializes in cosmetic and surgical dermatology, including Mohs Micrographic Surgery, as well as non-surgical rejuvenation of the face. Dr. Bishop graduated with honors from Wright State University School of Medicine, and served in the Air Force for nine years. He has lectured on dermatologic surgery techniques both in the U.S. and in Europe. You may contact Dr. Bishop at 321-751-9097.
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