Henry vs Fido

Today the feather I pull out of the featherbed is the claim that Americans (US variety) have the best health care in the world.

We have all heard the claim that here in the United States we have the best health care system in the world.  People are lining up to get here for our health care.  Actually, people are dying to get our health care.  Literally.  They are dying waiting to get into the system and get some care.  Below I discuss the health care of two good friends of mine:  Henry (not his real name) and Fido (also not his real name).

I was told this story by Henry’s significant other.  However, from conversations I have had with many people, it is not all that unusual.  See how your own experiences match up.
Henry had a problem in his gut.  It hurt.  He went to his family practitioner.  His practitioner looked him over and decided it was his bladder.  She referred him to a urology specialist, an assembly line sort of doctor who only did bladders.  The specialist botched the first scope, a horribly painful procedure so he performed it again.  Henry went back to his family practitioner and complained about having to undergo two scopes without arriving at a diagnosis.  Ho hum, said his family practitioner, and referred him somewhere else.
So here is the whole story from his significant other:
The procedure done by specialist 1 was a urethral scope.   He had to do it twice on the same day because the first time failed.   Note that every procedure done by all of the docs involves inserting a camera or device for snipping tissue from the bladder through the penis.   Each is painful (obviously) and left Henry with significant discomfort for several days following.
The second doctor was the one who was highly recommended.   He did the scope again, because he couldn’t (wouldn’t?) rely on the one performed by #1.  Following the scope, they knew there was a tumor.  #2 scheduled the procedure to remove and biopsy the tumor which involved the same process for inserting the device.  Henry had his sister come from Ohio to be with him for this.  Meanwhile, the day before the procedure doctor #2 called to tell Henry that he couldn’t do the procedure but another from his clinic could because he was in Oregon and couldn’t get back time.   Then, when Henry had a tantrum, the doctor called back and basically said he had misread his calendar and would be back in time.   Then the morning of the procedure, when Henry was already laying on the gurney without clothes on, doctor #2 and his staff had an argument in the examination room regarding whether the procedure might have to be rescheduled for sometime later because they had overlooked that he is allergic to latex and the staff thought the procedure should now be done at a hospital.   When Henry started to put his clothes on and leave, they decided they would do the procedure.
This is the doctor who called several days later to tell Henry he had cancer and that they wanted to begin BCG therapy in four weeks and offered no support.   They sent him one packet that included information on bladder cancer and BCG therapy, but when he read it, he focused primarily on what he read that was the worst outcomes and the negative side effects.  This is when he really started to lose it and became so angry with dr. #2 that there was a “mutual agreement” that he would go somewhere else.  Note also that the procedure done by doctor #2 seemed to have removed as much of the tumor as possible, but the lab report from the lab he used was contradictory, which made doctor #3 feel that he wanted to do the surgical procedure yet again, which became the 5th time there was a procedure involving inserting something through the penis.   Meanwhile, Henry had gone into a total meltdown because this is where his family practice physician was failing to meet Henry’s expectations for communicating with him.  Note that Henry’s expectations for return calls weren’t realistic in today’s medical environment, but in response to his urgent request to talk with her (I think perhaps on a Thursday), he received a call back from her physician’s assistant the following Monday.   This is when he switched to another doctor.   The new family practice doctor was a wonderful doctor in his day, but is past his prime.   He didn’t even know what the BCG therapy was that Henry was to undergo and is the one who put Henry on an anxiety drug, whose side affects were known.  Those side affects were contraindicated by Henry’s history and symptoms.  All the side affects were realized – the medication resulted in four weeks of paranoia, rage, bladder and bowel problems.   When I called this doctor’s office to let them know what was going on and to try to get help, no one at that clinic ever thought to look at the drug as the cause of the problem.
Anyway, once Henry got to specialist #3, that doctor wanted to do the insertion and biopsy again because he wasn’t satisfied with the results of the lab work from #2.  Once that was over, they began the BCG therapy which involves inserting live tuberculosis bacteria into the bladder (again through the penis).   The regimen involved six treatments of which he has completed four.  These are done by a nurse.   He has not seen doctor #3 since he began the treatments even though he is certain that treatments are inflaming his arthritis.  Also, the treatments are incredibly painful and he has tried to find out from this doctor if he can have some sort of anesthetic.  He finally has an appointment with doctor #3 tomorrow, but only after several ugly phone calls with the doctor’s office.   When he talked to doctor #3 on the phone about the complications with his arthritis, the pain and some of the other symptoms, doctor #3 responded that “none of my other patients have ever reported anything like this”.   The brochure that they gave Henry on the BCG therapy list exactly the same complications as reasons to “contact your physician”!  At least he has an appointment with doctor #3 to determine if he should finish the last two treatments.  However, it is important to note that if Henry would have been able to begin the treatment with doctor #1 back in September, he would be done by now and would be ready for a six month follow up.
I don’t really think his care is that much better now.  He needs to find a good family practice doctor who is willing to help him through all of this.  Specialist #3 is like the first two.   He is focused on the success of the initial procedure to remove the tumor and on the BCG therapy that he has ordered his nurse to do, but his bedside manner is poor.   None of them have understood how difficult this is for Henry and none have offered to help coordinate any sort of support through support groups, psych help, or god forbid simply sitting down and talking with him.
Now we get to Fido.  Fido is diabetic as a result of Cushing’s Disease.  When Fido came in, he was in pain.  Fido’s doctor sat on the floor to examine and diagnose Fido to avoid the discomfort of putting Fido on the examining table.  Fido’s doctor stated options and personally arranged care.  The clinic called Fido’s owner (Henry) daily to advise of progress and discuss treatment.  They performed hourly blood tests.  When Fido came back, they (the clinic and the main care veterinarian) together coordinated ongoing care so the vet would be apprised of existing treatments for her ongoing treatment.  When the dog began to lose eye sight due to the diabetes, the vet recommend one specialist.  When Henry was unhappy with that specialist, the vet was glad to get the feedback and promised to never recommend that person again.  She recommend a second specialist.  This new specialist and the vet spoke daily to each other and to Henry.  The vet watched medications for compatibility and balance.  Calls were returned within 1 day, unlike Henry’s doctors.  Henry was never put on hold when he called, whereas Henry’s doctors often required a 55 minute hold.  Fido is feeling much better now, but his vet still checks in.
The moral of this story is that if you want quality, unified care, call a vet.  Be a dog.
The feather I am pulling from the featherbed today is that American people have the best health care in the world.  In fact, if you are in America, you get better care if you are a dog.

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