What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Wednesday, September 05, 2007

What Is a Year Of Your Life Worth To You

It seems when a medical scenario arises that shows our health care system in a bad light, the avid supporters of maintaining the monopolistic public system cry “that’s just one case. You can’t bring up one case as though it is the norm”. But how do we know that it is not the “norm”. How do we know that we are receiving the best and most appropriate care? How do we know that we are receiving the right treatment at the right time? One very learned orthopedic surgeon once told me that the average Joe Public hasn’t a clue about whether they have received good care. When you, as a surgeon, know you have given your best, you may get sued; when you are sure you could have done better, the patient may sing your praises and send you gifts.
The following is the story of a patient who has not only agreed to my writing his story, but has encouraged me to do so. If, on the other hand, your mind is closed to criticism of our publicly funded system, save yourself the time of reading this, for if you believe it, you may be quite shaken and perturbed; but if you are going to rationalize and justify the situation, you have wasted your time reading of this real-life account.
So think about it. What is a year of your life worth? And what if those years are good quality years in which you can do all the things you are doing today-----earning your usual income, holidaying, making love, watching your children and grandchildren grow up, and being totally pain free. What is each year worth?

Chapter One: The Inertia of the System

I have often remarked that getting appropriate treatment in a timely fashion for a patient in our public system is like pushing a boulder up a hill. If everyone involved pushes hard and together, you make progress. When the pushing stops, progress stops. Unfortunately the disease process you are attempting to treat may not stop, and for the patient the “boulder” comes crashing down on them.
The following is the story of a sixty two year old man (we will call him LD) who was diagnosed with cancer and told he had six months to live; this is a man who on returning from the Cancer Clinic and having a full “team approach and opinion”, turned to me and said “I think they just sent me home to die”!
This saga begins two years after my retirement in the early days of October, 2005, at which time a previous patient of mine presented to his new family doctor with a complaint of change in bowel habit of three months duration. During routine work up he was found to have a liver mass (on abdominal ultrasound). Since the waiting time was considerable and he could afford the cost, he elected to have a private CT of the abdomen instead of waiting in the public queue). The CT confirmed three abdominal masses; one was 18cms by 20cms, one was 3cms by 3cms, and one was 3cms by 2cms. Furthermore, the CT suggested a 3cm by 2cm mass in the base of his left lung. At the end of October upon my return from a holiday a message had been left on my answering service. Apparently his family doctor had told him these masses could be cancer and that biopsies would have to be done. Three weeks had passed and he had no word of any time commitment for the biopsies. Could I please intercede and find out what was causing the time delay?
Placing a call to the appropriate diagnostic imaging department and a radiologist I knew from my years in practice, I found out that the referral had been made but no indication was given as to why the biopsy was needed, and no arrangement was made for a physician to assume responsibility in hospital in the event that complications arose following the biopsy. Upon my providing the appropriate information and arranging for a responsible physician, the required biopsy was done within three working days. O. K., at this point you may say that the family physician was incompetent, and you may be correct.
Within three days I telephoned for the pathology report and was told that this patient does indeed have a malignancy, a rare neuroendocrine malignancy, with various testing indicating similarities to carcinoid. Now carcinoids arise 95% of the time from the gut and less than five percent of the time from elsewhere, including the lung. The question now becomes whether the lung lesion is primary or secondary to a yet unidentified bowel lesion. I arranged for LD to see a specialist (specialist #1) within two days (again by using contacts established over many years of practice) and arrangements were made for a lung biopsy within a week. See, things can happen in a timely fashion in our healthcare system! Unfortunately, the lung biopsy came back negative, which simply means the person doing the biopsy missed the tumor. Forms were sent in to the Provincial Cancer Clinic and on a follow up telephone call some two weeks later I was told that although it was acknowledged that the patient did have cancer, until the origin of the cancer was determined, the cancer clinic could not book the patient into the appropriate department.
So I spoke to the neuroendocrinologist (specialist #2) involved at the cancer clinic, and was told that two special scans would need to be done and that a specialist would have to order the scans (I suppose it wasn’t in the provincial budget to allow a family physician to order the scans, or I suppose in the Cancer Clinics’ budget to order the scans). In any case, I gave the name of the specialist already involved (specialist #1), and was told the scans needed would be requested for him to arrange, and a request for this would be sent to him. Two weeks later I phoned specialist #1 and was told that he had received no correspondence regarding any special scans on my patient. I related to him the scans that were necessary and he arranged for the scans. Unfortunately the scans could not be done for two weeks since some of the material to do the scans had to be ordered and were not kept in stock, and that alone may take ten days or more. At last the two scans were done and the results sent on to the Cancer clinic confirming that the tumor was a neuroendocrine cancer, carcinoid in nature,that the lung lesion was the primary lesion, and an appointment given for mid Jan, 2006. When I phoned to see if things could be moved up I was told that it was the earliest the entire team could review the case and no priorities would be given. So we waited for the famous TEAM to consult.
In spite of my best efforts, three and one half months had elapsed from the time a CT demonstrated a likely cancer, until the patient would be seen in the Provincial Cancer Clinic. This in a patient that had been told his life expectancy was six months.
Tune in for Chapter two: This Is Our Opinion, and It’s The Only One You Will Get.

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