This blog has been years in the making–possibly long before I had ever heard the term ‘blog.’ Spurred on by the recent series of blogs by Henry which have at least indirectly addressed the medical profession and the sensitive and often incompatible relationships between doctors and patients, here I am ready to throw in my own two cents worth. Well, with inflation, make it a dime– or ten pence, or whatever your currency may be.
What gives me the right and immunity from moral turpitude to open my mouth (or computer) and discuss these issues? I do have a few reasons:
First, I have declared openly in previous blogs of my own hypochondriac tendencies. I don’t intend to elaborate in this forum, except to say that my recent novel “Welcome Home, Sir” (or on Kindle) deals with a scientist suffering from hypochondria and hiding it from his colleagues. For those interested in so-called mental illnesses and their potential impact on people, and scientists no-less, this is your opportunity. But I shall say no more on this particular matter now. The point is that hypochondriacs have a unique vantage point concerning doctor-patient interactions.
Second, I have lived almost equal periods of time in 3 countries, each with its own and very different system of medical care and insurance. This I feel qualifies me as a semi-expert in making comparisons, at least from these 3 systems.
Third, I work as a scientist at a major medical center, which provides me with a lot of peripheral insight into the way things work at a research and teaching hospital.
Finally, my own father is an pediatrician in Canada, and through frequent discussions I have gained a lot of knowledge of how things work–or rather how they don’t–on the northern side of the border.
So let’s start with the two radical opposites, situated so close together, yet so far apart in their respective medical systems. Here in the US, I feel that the medical care available (compared to Canada or Israel) is vastly superior. Of course, that depends on whether one has insurance and can afford that care. But if we remove cost from the equation–with money not an object as they say–I think there is little doubt that the system here offers the highest level of medical care. Specialists of all types available (this also has to do with the size of the country), and a plethora of high end medical tests routinely done.
Just a few years ago I was telling my father about an episode of cluster headaches I had been plagued with, and how my GP sent me for an MRI that they were able to schedule for the very next day. Why not, with dozens of MRI machines available at the various hospitals and clinics here in Omaha. Not an issue. Taken for granted. Yet my father had explained to me that on his side of the border in Winnipeg, a city roughly the size of Omaha (750,000), there were only 4 MRI machines in the entire city with a waiting time of 6-8 months for any test that wasn’t deemed a life threatening emergency. As a pediatrician, he had been sending families who could afford it to do private MRIs across the border in Grand Forks, North Dakota (population ~50,000), which had at least a dozen MRIs available.
So what is wrong with Canada’s socialist medical system? Nothing–except that it’s gone bankrupt. And people begin to take medical care for granted. So for example, if new vaccines (ie., chickenpox) are not covered by Canada’s medical system, the vast majority of patients will not vaccinate their children. Pay for vaccines? They must not be necessary if they are not covered. They are “frills” and frivolous.
Now I fully realize that these are all anecdotal comments and observations, and quite possibly regional differences within Canada make things better (or worse?) in other areas of the country. But as I am not writing a peer-reviewed paper now, but rather just passing along my impressions, I have no qualms about making these observations.
I won’t say much about the system in Israel (because it generally falls in between the US and Canadian systems), except to note that I often encountered a weird situation in Israel. While doctors here in the US will do a battery of tests to ensure that the patient is healthy and that they are not missing any hidden ‘signs’ about the patient’s health, in Israel I’ve noticed that many doctors seem to do the opposite. They try to show the patient that he/she is healthy. So coming to an orthopedic surgeon without a torn ligament, but just moderate pain in the patella region (that’s hard to quantify), someone such as myself always had the uncomfortable feeling that the doctor thought I was trying to “cheat”–perhaps to get a doctors note to avoid military reserve duty? Or work?
My hypothesis is that since most doctors served for some time in the military and did encounter hordes of sick and not-so-sick soldiers, some of whom were indeed trying to evade one type of duty or another, this has caused generations of physicians to become overly suspicious of patients’ complaints and colored their vision of the medical profession even in civilian duty for years to come. It’s certainly no fun seeing a physician who doesn’t really believe you when you profess your symptoms. All the more so for any issues dealing with mental health…
Back to Canada, (or at least Winnipeg) there seems to be an acute lack of certain specialists–children in Winnipeg in need of pediatric nephrologists need to fly to Toronto or Vancouver. And this is only one example.
Having children, I have visited pediatricians here in the US many times. The doctors seem to have a lot of time for each patient, to answer parental questions and do full physicals. Nurses and assistants give the vaccinations and do the weighing and measuring. Sources tell me that pediatricians typically see 20 or so children a day in a US clinic. In Canada 50-60 is more typical; doctors are paid much less and also do not usually employ nurses and assistants for vaccinations and measuring/weighing. Where would you expect care to be better?
But as I alluded to earlier, better care depends on the ability of patients in the US to handle their medical costs, or be covered by insurance. Those unable to pay and up to their eyeballs in debt can burn out their retinas with no help on the way. For many, getting sick just isn’t an option; the only possibility is emergency room visits–often when it’s too late. Stories abound of chronic illness causing families to sell their homes and undergo painful bankruptcy. A merciless system, and one that some democrats in the US have been dreaming of improving for years. Time will tell how much Obama’s health care plans and reorganization of the medical insurance system will improve matters.