A friend of mine has a good friend who is currently in hospital dying of cancer. He was admitted to the hospital seventeen days ago with back pain; spent ten days having X-rays and scans at the local hospital; was transferred to the nearest big city where he spent six days waiting for biopsy results to be sent to and returned from Mayo; and yesterday was to be operated on–but lost too much blood, the cancer turned out to be too far advanced, and the operation was cancelled. He is now in the ICU waiting to die. He is in his mid-twenties and was to be married this month.
My friend’s question is, what is the relative quality of medical care here in the US as compared to other places in the world? They are both from India, and very frustrated by the waiting, the waiting some more, and the failed operation. They say that they never hear stories like this about medicine in India. I, as an American, am all too familiar with stories like this. Still, my knee-jerk impression is that quality of medical care in the US (provided you have good insurance) is excellent, and that the friend’s friend is probably being treated as best as was possible given the circumstances. Am I wrong?
Perhaps if he’d been admitted to a “big city” hospital immediately, the diagnosis would have been quicker. But, for a guy his age, cancer was probably not considered the most likely diagnosis.
Might diagnostic imaging have shown that surgery would be a wasted effort?
Whatever the hospital–it sounds as though no good outcome was possible. Very sad.
It sounds like a dying young man is looking for something to blame for the fact terrible things happen you can’t fix. The care you described doesn’t sound bad, just too late. Stay strong and help him through the remaining time, it will be harder on some day’s than others. I wish I could help, but this wish is all I can do. You can be there as a stalwart friend.
Since this is IMHO and not GQ, I’ll venture an opinion.
First, there will likely be a few shallow-thinking posters that will come into this thread and throw around some statistics that, “proves,” American health care sucks. Namely, we have poor life-expectancy compared with other nations that spend less money on health-care, etc. Unfortunately, none of these indicators for health-care quality control for lifestyle, obesity, or any other important health risk factors. Also, are we going to include questions of healthcare access or presume that the hypothetical patient in this thread has relatively good health insurance? Does waiting around for a coronary-bypass surgery in the UK’s NHS’s carefully risk-controlled waiting lists count as poor healthcare?
Unfortunately, there just doesn’t exist an organization in the world that provides meaningful comparisons of the relative quality of actual healthcare. There are some means of comparing hospital quality in the United States, but no one fairly compares healthcare how well respective systems deliver given interventions nor how likely someone is to receive an appropriate intervention.
That said, my humble opinion is that I would vastly prefer to be afflicted with some serious condition in a hospital in the United States than any other healthcare system.
I didn’t want to bring this debate into a, “personal,” thread but for a point of comparison, Sierra Indigo has recently posted several threads about her and her partners experiences with the Australian health-care system and seemed extremely dissatisfied. IIRC, her husband presented to the emergency department of a hospital several times with severe abdominal pain related to NSAID abuse. Several times, he was given analgesics for the pain and basically told to follow up with his family physician, eventually getting scheduled for the endoscope that diagnosed his GI bleed on an outpatient basis. To be brief, it seemed to me as if the care he received was far below the standard of care that could have been expected at a hospital in the United States. Here’s an eMedicine article on upper GI bleeds that gives a bit of perspective on how I think such a condition was likely to be treated in the United States:
Although I think our hospital based care for serious acute problems is very good, I think that primary care is underfunded and underutilized. I get the impression that centrally planned healthcare systems tend to do a better job of recognizing both the short and long term value of primary care and provide it with more resources. Perhaps this is a large part of the reason that we spend so much on healthcare relative to similarly developed nations yet often seem to be lacking in population wide healthcare outcomes. Primary care is a much better “investment” in terms of improved health outcomes per dollar spent than acute hospital based interventions.
Well, although our health care in Canada is universal, we are always hearing that the quality of health care (for those with insurance) in the U.S. is far superior.
Most people who can afford it would rather pay to have quick and better service in the U.S. than languish through the public system in Canada.
Your access to health care can be an issue. The quality of heath care is probably the best in the world.
Who is telling you that your health care is inferior? Those with a vested interest in privatization?
A co-worker of mine recently took early retirement; she & her retired husband have recurring health problems. (Although they were well insured here.) She moved back to Canada. Primarily for the health care.
Sorry to hear about his situation.
It sounds like he probably had an unusual kind of cancer (considering his age and the second opinion from Mayo) so that probably had more to do with the delays in diagnosis than the quality of the hospital. Unfortunately, it probably was already too late by the time he started having the pain. Speaking generally, it would not be likely for a cancer would go from curable to unresectable within 17 days like that.
I’m not sure if the friend’s condition is stable enough to be considering any other treatments but they may want to look into the clinical trials at http://www.clinicaltrials.gov/ to see if anything there might be applicable to his type of cancer, if they want to be sure that he had every possibility explored.
All the best to him and his loved ones.
Did this young man have decent insurance in the US? There is a world of difference between insured and uninsured health care here.
But, to give you an example of how the medical system can be especially problematic with cancer… My sister had a checkup and a they found a suspicious mole on her foot. She immediately made an appointment with a dermatologist for a biopsy – and the earliest she could get in was 5 months later. The mole turned out to be melanoma. My sister was very lucky, because in that time it could have grown to a point that gave her very litle chance of survival, but it turned out to be very slow groing and she’s ok now. And she has very good insurance.
This question is unanswerable, or more precisely: there are too many answers. Statistics can prove anything; so can anecdotes.
Personally, I’m rich in anecdotes, having lived abroad for years and now dealing with parental health problems that have almost certainly been exacerbated by poor health care in both the US and Mexico. On the whole, my personal experience suggests that health care sucks in Mexico and Egypt, sometimes sucks in the US and Indonesia but is sometimes okay, and is great in Singapore and South Africa. But I am positive all of those assertions could be countered.
To me, this is a great illustration of how much dumb luck plays a part in the quality of health care. In the past year I have had several suspicious moles taken off. I made an appointment to have two looked at because they were bothering me, and got in to the dermatologist the same week. They then decided to “section” me in one-month intervals, which was a further four appointments (arms, front, back, legs). Every time I went in, the results from the previous section had come back. This was with ordinary university-employee insurance. It was good insurance but not particularly special.
This guy had a good job and has good insurance, and the medical system around here has struck me as being incredibly efficient.
It depends heavily on where you live in the U.S. as well. I live in the Boston area and I don’t have any reason to think that I don’t live in the best health care city in the world and we have needed it over the past five years. I will keep it short but we had a baby daughter die from one of the rarest genetic diseases in the world (50 cases ever reported). She was admitted to Children’s Hospital Hospital immediately and we knew within two days that going from a perfectly healthy state to terminal seizures created the inevitable. The problem was that many of the top doctors in the world could not diagnose her problem but they absolutely did not give up. We were given an apartment with the neonatal unit at Children’s Hospital and Sophie lived in it with us for 5 weeks. We had not only a dedicated nurse but also a 4 person team of grief physicians that came by every day and made sure that we had everything we needed and that included everything within reason. Her actual care doctors met with us once a day as well. Keep in mind all of this was after we knew that she wouldn’t make it.
The incredible part happened right before she died. No test existed for this disease and we wanted to have another child but we learned that it would be really risky because any future children would have a 1 in 4 chance of having it and it would be 100% fatal as well. A team of doctors and Harvard researchers promised to invent an in utero test for the genetic problem. My wife got pregnant again way faster than we expected yet we had this genetic problem looming over our heads. Researchers raced around the clock to invent a test. They succeeded at month five of pregnancy just as my wife was beginning to show (we couldn’t tell anyone until we knew). The test came back clear. Little Olivia is 18 months old now.
We owe Childrens Hospital and Harvard everything for that. It doesn’t stop there. I needed some of the best treatment in the world for some issues I was having and I got it including some bleeding edge treatments from Harvard as well. It goes on and on. I have never waited for care at all for anything here and no expense has been spared. My primary care doctor always has appointments available with 2 - 4 hours notice. I had to inpatient in the hospital twice in the last month because of the flu. The first time was a 2 hour wait and the second none at all because they reserved a bed for me.
I really, really like the health care here and have had experiences that ranged from the positive to the extraordinary and incredible.
…And while I’m very happy that Shagnasty is happy with his health care, I’m sitting here in Indiana with no health insurance and a husband who was born with spina bifida, has diabetes and carpal tunnel syndrome, and who we still have not gotten onto disability (yes, we’re working on it). Thank Og his doctor has out and out given us a three month supply of his most expensive medication and we’ve managed the rest, but when you’re unemployed with little to no income having to scramble for the medication that keeps your loved one healthy and out of the hospital is just one more aggravation in the day.
What good is this “best medical system in the world” to me if I don’t have access to it? Well, OK, technically I have access to it, but I have to be either actively dying (in which case I’ll get whatever is needed to keep me breathing before being dumped out on the street and handed a big ass bill) or getting it will strip me of every asset I own and leave me destitute for life?
I’m not an expert on cancer but I’m questioning whether seventeen days would have made a difference in any cancer’s diagnosis and treatment.
It’s probably also worth noting that in the case of Sierra Indigo, the fact that her husband was abusing NSAIDs was deliberately concealed from medical personnel until his last hospital admission. If it had been revealed early, it would have made all the difference.
