Posts Tagged United States

Fat Nurses Need Not Apply

A Texas hospital has declared war on the scourge of obese nurses:

A Victoria [Texas]  hospital already embroiled in a discrimination lawsuit filed by doctors of Indian descent has instituted a highly unusual hiring policy: It bans job applicants from employment for being too overweight. 

The Citizens Medical Center policy, instituted a little more than a year ago, requires potential employees to have a body mass index of less than 35 — which is 210 pounds for someone who is 5-foot-5, and 245 pounds for someone who is 5-foot-10. It states that an employee’s physique “should fit with a representational image or specific mental projection of the job of a healthcare professional,” including an appearance “free from distraction” for hospital patients.

“The majority of our patients are over 65, and they have expectations that cannot be ignored in terms of personal appearance,” hospital chief executive David Brown said in an interview. “We have the ability as an employer to characterize our process and to have a policy that says what’s best for our business and for our patients.”

It all sounds so, well, high-schoolish, and I don’t think the CEO is seventeen, though he’s acting like it. I mean, can you get any more shallow? Since when does physical appearance have anything to do with competence or worth or dignity of any health care professional?

Or maybe David Brown doesn’t really believe nurses actually have skills — we just stand around as decoration, lookin’ pretty.

And fitting the  “representational image” of hospital employees to meet patient “expectations?” What the hell does that mean, anyway? If  patients expect this (and this is a pretty common “representation”)

A representational image of a nurse

then hiring practices should make sure all nurses are boobalicious? What if the patients want all-white nurses? Or all females? Or no Muslims?

The man is a bit of a dink, obviously. I can only imagine how valued overweight nurses employed by this hospital must feel.

The article goes on to note that this David Brown, CEO of Citizens Medical Center, has some issues. In 2007  he wrote memo about some foreign-born physicians in which he  stated: “I feel a sense of disgust but am more concerned with what this means to the future of the hospital as more of our Middle-Eastern-born physicians demand leadership roles and demand influence.”  He continued, “It will change the entire complexion of the hospital and create a level of fear among our employees.”

Needless to say, there is a discrimination lawsuit over that.

So let’s summarize what the leadership at Citizens Medical Center believes: scary scary fat nurses scaring patients. Scary scary dark-skinned physicians scaring employees and patients.

Clearly a place where I would want to work. Or be treated.

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How to Eat in the Most Obese County in the United States

Let’s start with an appetizer:

One thing you need to know before going to the Mississippi Delta is what a Kool-Aid pickle is — and how to make it.

1. Pour pickle juice from a jar of pickles into a bowl.
2. Add Kool-Aid to pickle juice.
3. Pour pickle juice back over pickles.
4. Enjoy?

Where can you find Kool-Aid pickles? All over the region, including at the Double Quick, a chain of convenience stores, many of which also sell a smorgasbord of fried foods.

The video, produced by the NPR and Oxford Magazine, documents the difficulties eating well in (putatively) one of the richest agricultural regions on earth, where fresh, unprocessed food is the exception. Not surprisingly, there is a close relationship between poverty and poor diet; the devastating sequellae of diabetes, hypertension, heart disease and stroke, it hardly needs to to be said, ends up afflicting those least able to afford the health care, drugs and lifestyle changes necessary for effective management. Note the interview in the grocery store, and the dearth of fresh vegetables, apart from a few over-processed tomatoes and cucumbers.

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Having a Mental Illness Makes You a Security Risk

This is just disturbing:

When Lois Kamenitz arrived at Pearson International Airport in November, hoping to board a flight to California, she was stunned to learn that U.S. border officials were barring her entry. The reason: Years ago, she attempted suicide.

The 64 year-old Toronto woman was fingerprinted and photographed. She questioned the U.S. Customs and Border Protection officer about how he accessed her medical records. He said he didn’t. Instead, he knew police had attended her Toronto home in 2006 because she had done “violence to self.”

[snip]

How and why her personal information was passed to a foreign government is extremely troubling, say advocates for civil rights and the rights of psychiatric patients, who believe Kamenitz’s privacy rights were invaded.

It’s not an isolated incident, says Ryan Fritsch, legal counsel for the Psychiatric Patient Advocate Office. He has heard of about eight similar cases in the past year, all involving non-criminal contact between police and people with mental health issues — records of contact that end up at the Department of Homeland Security.

Considering 20% of Canadians will have a mental illness during their lifetime, the direct and indirect costs to the economy, and the stigmatization that presents a serious barrier to care and treatment, further demonization of the mentally ill by labelling them as a “security risk” hardly seems helpful to anyone. Supposing you suffered from depression, and your employer sent you across the border on a regular basis. Would you take the risk of disclosing your depression if it would end up in the hands of government agents who may or may not arbitrarily deem you a risk?

The confidentiality/privacy issue is a whole other matter. Suffice to say, you get the feeling any meaningful protection of personal information is probably a sham, and if you care about such things, you should disclose such information bearing that fact in mind.

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Not Charted, Not Done — And The Patient Suffers

I was seconded a little while ago for a couple of weeks to do administrative duties, among which were some chart audits. This is where we pulled old Emergency Department charts and compared them to a check-list of essential criteria for having sound documentation. We looked at whether initial nursing assessments were complete. Were vital signs taken according to policy? Were the orders signed off? Were discharge instructions given? The list was long, and almost each check-off represented a point where a nurse could be called to account for poor practice

For reasons of  liability, accountability, and most importantly, patient safety and continuity of care, good charting is a nursing essential. Why? Because the chart is the principal way health care professionals communicate with each other. We all make clinical decisions based on the information found in the chart, and if information is missing or inaccurate, we may jeopardize patient care.

And frankly, in the never-ending Quest for Good Charting, we collectively sucked.* I’m not talking about whether nurses were completing Form 5435-xy-125 documenting the chain of custody of the patient’s lower plate, either. There were some pretty egregious examples. No initial vitals signs charted on some charts. No assessment of peripheral capillary refill on children. No chest assessments on patients with presenting with cough and dypsnea. A patient in hypertensive crisis given an antihypertensive with no follow-up blood pressure documented. I was actually embarrassed for my colleagues — and myself. To be clear, I am not suggesting that the nursing care was ever as poor as these charts might suggest, though the blood pressure chart did give me pause. But it’s also an old maxim that “if it isn’t charted, it isn’t done.”

The missing piece of information which bothered me the most was the lack of charted pain evaluation, and unfortunately in this instance, I could show pain was not being assessed at all. Let me explain. Lay people who have travelled in the land of health care are probably familiar with this question: “On a scale of one to ten, with ten being the worst possible pain, how would you rate your pain?” This question is important, and not only for the obvious reasons of providing effective pain control. In the Canadian Triage Acuity Scale (CTAS) system, the pain scale forms a crucial element of determining a triage score and in turn, priority of care, because the level of pain is correlated to the severity of the patient’s condition.

Alarmingly, many of the charts audited had no triage pain assessment, meaning the triage score was unreliable. Patients presenting with chief complaints of back pain, for example, were routinely triaged as “4,”  that is “Less Urgent,” without any pain assessment being done at all. A pain scale of  8/10 would bump these patients to CTAS 2 (Emergent),  which of course determines a whole other priority for care. I understand why the chief complaint of “back pain” did not receive adequate pain assessment: patients presenting with such are often unfairly labelled as drug seeking. Trouble is, I can think of many problems which present as back pain, that are unrelated to either mechanical injury — which can be serious enough —  or drug seeking behaviour, ranging from renal calculi to dissecting aortic aneurysm.

The point is, poor charting on the part of nurses can lead to bad patient outcomes. Part of the problem is that nurses are overwhelmed by the documentation they are required to managed. Charts are full of administrative trivia unrelated to the actual provision of health care, yet nurses are expected to treat this flood of paper as being as important as documenting the care itself. (I know this situation is far better in Canada than the United States, where charts take on encyclopedic length before ever leaving the ED.) When nurses face ever-increasing workloads, higher patient acuities  and volumes, and the consequential time constraint, the choice is often literally between actually saving lives and writing it down in the chart in an adequate manner. Guess which wins.

But in the end is the plea of “I don’t have the time for good charting” really a good excuse, especially when licences are potentially on the line? This is to say, nurse managers must be pro-active in insisting their staff are given the space to chart properly, and front-line nurses must be equally clear good charting is not optional. Yet, to be honest, in reading though the charts during the audit, I sensed that a lot of nursing care was routinized, that there wasn’t much critical thinking going on between the lines — what wasn’t charted was, in fact, never done. For good patient care, this is the greatest danger of all.

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*Note to any educators: an hour or two of chart auditing is guaranteed to cure the most recalcitrant nurse of poor charting. I think of myself as a reasonably conscientious charter, having worked in the U.S., but even for me, it was a real kick in the pants.

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Haiti Cholera Update, and Some Notes on the Scandal of Water

The Pan-American Health Organization (PAHO) reports (PDF) as of 1800 yesterday, 24 October 2010, there have been 253 deaths from cholera and 3015 confirmed cases. This represents a crude mortality rate 8.4%. Cholera treated promptly has a mortality rate of 1-2%. According to PAHO, 46% of deaths have been in the hospital setting, the balance in the community. Twelve cholera treatment centres are being built in strategic points, in the Artibonite and Centre regions, as well as in Port-au-Prince.

According to the Partners in Health (PIH) Twitter stream, the identified cholera patients in Port-au-Prince came from the areas already infected. This might be considered reassuring. At l’hôpital St-Nicholas in St-Marc, 600 patients were triaged. If you work in a Canadian or American ED, you can appreciate how overwhelming that number is. Médecins sans frontières has set up two triage streams at the hospital, for cholera cases, and all other patients. PIH is also tweeting that 10 cases have been reported in Gonaïves, largest city in Haiti’s Artibonite region. In general, reports of cases are moving southwards and inland.

Some notes on the scandal of water in Haiti

Access to clean water, considered a basic human right by the United Nations, has been severely hindered in Haiti, including the Artibonite region, because of the foreign policy of the Clinton administration, which blocked loans to improve the country’s water supply. According to PIH:

In 1998, the Inter-American Development Bank (IDB) awarded $54 million in loans to the Haitian government to improve the country’s patchwork, crumbling public-water system. The money was intended to bring clean water to people who for many years had been denied this basic human right, with devastating consequences for public health. Ten years later, however, this desperately needed money has not produced a single improvement to Haiti’s water supply in the city designated to be one of the first recipients.

[T]he United States government’s clandestine efforts to ensure that political considerations (namely the desire to destabilize Haiti’s elected government at that time, led by President Jean-Bertrand Aristide) took precedence over the rights of some of the planet’s poorest and most vulnerable people.

[snip]

Internal documents from the U.S. Treasury Department and the office of the U.S. Executive Director at the IDB, obtained through Freedom of Information Act requests, show that officials actively used American influence to block the loans in an attempt to destabilize the government led by President Aristide, who was ultimately overthrown in 2004.

Joia Mukherjee, Chief Medical Officer PIH, explains how this political interference, coupled with natural disasters and environmental degradation, made the current outbreak of cholera almost inevitable:

The city of St. Marc (population 220,000) and region of the lower Artibonite (population 600,000) were among the areas slated for upgrading of the public water supply. This project was delayed more than a decade and has not yet been completed. We believe secure and free access to clean water is a basic human right that should be delivered through the public sector and that the international community’s failure to assist the government of Haiti in developing a safe water supply has been violation of this basic right.  Additionally, in Gonaives the capital of the Artibonite has been destroyed in two waves of floods and mudslides, after tropical storm Jeanne in 2004 and after the series of hurricanes in 2008, made possible because of the environmental devastation of the region. The destruction contaminated the water supply and left the infrastructure (including the health infrastructure) of the upper Artibonite in ruins, forcing people to seek residence and medical care in St. Marc. The St. Marc region itself experienced significant flooding in 2008, displacing thousands of people. Lastly, the earthquake of January 12, 2010 resulted in the displacement of 1.7 million Haitians. While reliable statistics are not available currently, the last estimate, as of March of 2010 was that 300,000 addition Haitians had fled Port au Prince to the Artibonite. As there are no “camps” in the region, these displaced persons are “home hosted”—joining poor relatives in already overcrowded conditions, without water security or adequate sanitation.

If there ever was a sign where evil hits the road, it would be here.

Media reports on the epidemic here.

Another great resource: Haiti: Operational Biosurveillance. (Twitter)

On the ground, good sources of information and of course needing donations:

Partners in Health (Twitter).

Médecins sans frontières.

[UPDATE: corrected mortality rate]

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Code

She was killed by a conspiracy of circumstances.

Early in my career, I worked in the U.S., in a teaching hospital in a midwestern city. The hospital was authoritarian in its management. Policy and procedure was centrally dispensed. Nurses had little, if any, control over their practice. All the hallways, without exception, were painted a rigid, unrelieved white — the hospital’s “colour” — as if to symbolize this authority. Morale was dismal. Teamwork was non-existent.

The Emergency Department in this hospital consisted of three “pods”: three nursing areas, each in the shape of a square, sixteen beds in a pod, all monitored beds, a nursing station in the centre. There was a Trauma Room in one of the pods, but otherwise, patients went to beds undifferentiated in acuity or complexity. New onset strokes lay beside fractured femurs who lay beside minor lacerations who lay beside the intubated head injuries.

Three Registered Nurses were assigned to each pod. They were assisted by an “ER tech” who did ECGs and other scutwork, a housekeeper, and by a ward secretary whose only job (it seemed) was to answer the phone. All the RNs, save for two, were white; all the housekeepers and techs were African-American. Working at this hospital was an education in American race relations and racism.* The tension was nearly visible at times. Moreover, on any given shift, two or three agency nurses of uneven skill were on the roster. The hospital administration had decreed, as a cost saving measure, these agency nurses would not be paid for missed breaks. No matter what the condition of the department, therefore, the agency nurses could be depended upon to take their breaks.

The night the patient died, I was in Pod 2. It was busy. I had five patients in beds, including an intubated CHFer and a restrained psych patient needing checks every fifteen minutes. As a sort of bonus, I also had a patient in the hallway in front of the nurses’ station getting intravenous hydration before discharge. I was working with Janet, one of the two black nurses, an old hand at emergency practice, calm and collected, and Christine, an agency nurse, a regular, fiftyish, with a superfluity of jewellery. They had equally heavy patient loads: Janet, in particular, was kept busy with a stabbing (minor lacerations) and a restless Alzheimer’s dementia waiting for a bed upstairs.

Around 2030, Janet got a new patient, a 39-year-old patient with cough and increased shortness of breath, with a history of insulin-dependent diabetes. Her husband and her two teen-aged sons accompanied her, the elder of which had just come from football practice: he was still wearing the green-and-white uniform of the local high school. When I walked by her cubicle, I looked in: she looked unwell, pale, diaphoretic, her hair hanging in dark strings from her forehead. Janet assessed her, put the chart up for the physician to see; she then reported off to Christine, and went to break. I asked Christine about her.

“She’s probably a pneumonia,” Christine said. “She’s known to us. Her vitals are stable, her blood sugar is okay. She been here before with the same.”

While Janet was on break, the physician saw the patient, and she ordered a cardiac work-up, in addition to the usual sepsis blood work. This included an ECG. The usual practice, once the requisitions were filled out, was to delegate the ECG to the ER tech; if the tech wasn’t able to do the ECG, the responsibility fell back to the nurse. Christine said later she asked the  ER tech to do the ECG, but the ER tech promptly went to break. The ECG wasn’t done.

Just afterwards Janet came back from break. By now it was hideously busy. But Christine reported off to me, meaning to go to break; she wasn’t, she said, about to sacrifice herself because of a “stupid hospital policy”. She neglected to tell Janet about the physician’s assessment of her diabetic 39-year-old, nor about the orders. The ECG still wasn’t done. In any case, Janet’s dementia patient had fallen out of bed, she was incontinent; there was a mess of stool and urine. I went to help Janet.

Cleaning and resettling the dementia patient took some time. When we came out again, it was nearly 2245. Christine was back from break, charting. I glanced at the cardiac monitors. The diabetic’s heart rhythm, the morphology, was abnormal.

“Your diabetic lady,” I said to Janet. “It looks like she has ST elevation.”

“I thought the rhythm looked a little weird before I went,” said Christine. “I wondered if something was going on.”

At that moment the ER tech came trundling up with the ECG machine. The ECG still hadn’t been done.

“Fuck,” Janet said.

We paged the physician overhead, ran to the diabetic patient’s bed, did the ECG. Her sheets were soaked from sweat, and we had difficulty placing and maintaining the electrodes on her cool, wet skin. There was enormous ST elevation in the inferior and lateral leads. She was having a heart attack.

The emergency physician came. Soon, the cardiologist came down, and we were prepping the patient for the cath lab. Two IV lines, antecubital, high flow oxygen, consents signed. Her husband and sons were asked to go to the waiting room. Her blood pressure bottomed out; we bolused saline and hung dopamine. She went unresponsive, and the monitor showed ventricular tachycardia. She was pulseless. I started compressions and someone called a code. We defibrillated. Her rhythm went to ventricular fibrillation. We shocked again. Asystole. No electrical activity in the heart. We pushed drugs, epinephrine and atropine, did chest compressions. Asystole. After a half hour, her skin was mottled purple on her trunk and legs. The cardiologist called off the resuscitation. She was dead. The cardiologist remarked, in an almost off-hand way, that her death was unnecessary. A little while later, hospital administration arrived. The death, in that grotesque hospital-speak, was a therapeutic misadventure, a sentinel event. Janet faced an inquisition over her care: clearly, from the hostility of their questions, they were looking for a scapegoat.

If you want a proximal cause, the patient died because the ECG wasn’t done promptly. It is true too that Janet neglected the red flag of the patient’s diabetic history, both increasing the risk and concealing obvious symptoms of a cardiac event. The patient had no overt chest pain; she didn’t present as a heart attack. The hospital administration used these as grounds to fire Janet, even though the lack of an ECG was not really her fault: she was still ultimately responsible for the patient. But like most sentinel events, the real reasons for the patient’s death were more complex. There were circumstances. The lack of teamwork, poor morale, hospital policy regarding breaks, the inadequate staffing, the design of the department, the patient flow and assignments, the use of agency nurses, the high levels of patient acuity and complexity when the patient arrived in the department, the lack of clear policy around ECGs  — all of these conspired to kill the patient.

As for me, I went home and intentionally got drunk for the first time in my life. I felt as though I had personally killed the patient. When I walked by the patient and glanced in, I knew she wasn’t well. Should I have intervened more directly? It’s a question which has haunted me since. I don’t know the answer. But I have never walked by such a patient since without ensuring to my own satisfaction their care is appropriate. There was one further consequence for me: a week later, I resigned and came back to Canada.

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*A Filopina RN, a recent arrival to the U.S. and someone who I was quite friendly with, said to me one day, “This hospital does not like brown people.”

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Physicians and Torture

Torture is a health care issue. Especially when physicians are complicit, as they evidently were during the Bush administration, in the CIA’s Office of Medical Services, where they facilitated torture of prisoners: [via The Daily Dish: the original JAMA article is behind a paywall.]

An important new study came out today. It’s from the Journal of the American Medical Association about the deep and unethical involvement of CIA doctors and psychiatrists in pioneering torture techniques for the Bush-Cheney administration. . .

The CIA Office of Medical Services

  • purported to subject some techniques to “medical limitations,” but those claimed limitations imposed no constraint on use of torture, e.g., allowing weight loss up to serious malnutrition, noise up to level of permanent hearing damage, exposure to cold water right up to development of hypothermia, shackling in upright sitting or horizontal position for 48 hours (and longer with medical monitoring);
  • placed no medical limitations at all on the use of isolation, hooding, walling, cramped confinement or stress positions except in some cases avoidance of aggravation of pre-existing injury;
  • ignored medical and other literature on effects of these forms of torture, and instead cited sources like NIH web site, wilderness manuals and WHO guidelines.
  • recognized dangers of certain enhanced methods but nevertheless approved them, e.g., that waterboarding risks drowning, aspiration pneumonia, and laryngospasm; sleep deprivation can degrade cognitive performance, lead to visual disturbances and reduce immune competence acutely; prolonged standing can induce dependent edeme, increased risk for DVT, cellulitis.

I spent a considerable amount of time yesterday trying to imagine circumstances where health care professionals in a supposedly free society could justify their participation in torture of their patients. Because there is no way around this bald fact: those being tortured were patients of these physicians. They assumed care; they took up responsibility for their treatment and well-being.

I came up empty. I suppose one could make the argument that physician participation mitigates the worst effects of torture, as if having waterboarding (for example) supervised by medical personnel somehow minimizes poor outcomes and creates and justifies acceptable practice. In short, it’s all routinization and normalization: torture as a medically prescribed treatment. But do we really want torture to be medically “administered” to ensure acceptable outcomes?

There are certain ethical touchstones all health care professionals must abide by: beneficence, non-maleficence, autonomy and justice. We must work for the patient’s good. We must not do harm. We must respect the patient’s choices in accepting or rejecting treatment. We must ensure patients are treated equally without regard to externalities. It’s hard to see which of these principles isn’t grossly violated.

“Conduct disgraceful and dishonourable to the profession” is the traditional formulation when health care professionals are found guilty of misconduct. I guess it would apply here.

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Acquitted

In less than an hour.

A West Texas jury took but an hour Thursday to acquit a nurse who had been charged with a felony after alerting the state medical board that a doctor at her hospital was practicing unsafe medicine.

The uncommon prosecution had ignited deep concern among health care workers and advocates for whistle-blowers about a potential chilling effect on the reporting of malpractice.

But after a four-day trial in Andrews, Tex., a state court jury quickly found that the nurse, Anne Mitchell, was not guilty of the third-degree felony charge of “misuse of official information.” Conviction could have carried a prison sentence of up to 10 years and a fine of up to $10,000.

A civil suit is now pending against the hospital, sheriff, and physician. Let’s hope they’re all spanked thoroughly, and the nurses involved get the best restitution of all: cold, hard cash.

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Punish the Nurse

I know this case as been making the rounds of the health care blogs, so if you’ve seen it before, you can perhaps safely ignore this post.

For everyone else, do you know what happens when nurses get all uppity and ethical and report a physician for breaches of safe practice? You get arrested and threatened with ten years’ imprisonment:

When veteran nurse Anne Mitchell wrote a confidential letter last year to the Texas Medical Board, complaining about a doctor she thought practiced shoddy medicine, she assumed it would be anonymous.

Instead, Dr. Rolando Arafiles Jr. fired her after reporting her to the local sheriff — a former patient and admirer of the doctor — for maliciously ruining his reputation.

Police in Kermit, Texas, searched Mitchell’s computer and found the letter, then charged her with “misuse of official information” in her role at Winkler Memorial Hospital, a third-degree felony in Texas under an abuse-of-power statute.

Today, 52 and out of work, Mitchell could face 10 years in prison for doing what she believed was her obligation under the law — to report unsafe medical practices.

Arafiles had, among other things, sutured the rubber tip of a glove to a crushed finger in order to protect it, and performed a skin graft in the Emergency Department which subsequently (and unsurprisingly) failed. In that wasn’t enough, Arafiles was flogging his own herbal remedies, consisting of white grape juice, to his patients on the side while providing treatment.

The second day of the trial proper was yesterday, and was full of interesting information. According to a local account, it turns out the arresting sheriff, who was so full of love and admiration for the good doctor, was selling the herbal supplement on side. And, incredibly, the physician himself thinks diabetes has no impact on wound healing.

It’s an unfortunate confluence of corrupt local politics and hospital complicity — the administration where Arafiles worked was fully aware of his shortcomings and refused to act — in a toxic culture of entitlement, where if things go wrong, and accountability is demanded, you blame the nurse. In the end, you have to wonder who needs to be on trial.

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In Praise of Canadian Health Care, Warts and All

I’ve been following the American health care debate, somewhat — it’s like watching a slow-motion train wreck, except less fun. The chances of any substantial legislation passing appears now to be derailed for another 20 or 30 years, or maybe forever, because it’s hard to imagine a more auspicious conjunction of the political stars. So Americans must now make themselves believe (again) they have the best health care system in the known universe, with infant mortality rates higher than Cuba, and Canadians can still retain their annoying moral superiority about our system, which frankly, has vast swaths of suckiness. Just ask any Canadian RN or physician.

And yet. Maha at Call Bells Make Me Nervous posted this:

Several shifts ago, I was assigned to an area with five rooms. In one of the rooms was a homeless man who was being treated for cellulitis and hyperglycemia. He was eventually discharged to a community care centre where home care nurses would take over. After the room was scrubbed clean, another patient was brought into the room. The second patient was a fairly well known celebrity. I thought that it was remarkable that two people with completely opposite socioeconomic backgrounds were treated in the same hospital, in the same room by the same team of doctors and nurses. The Canadian health care systems may have its problems, but it was nice to see it actually working as intended.

And also this comment on another post of mine by At Your Cervix gave me pause for reflection: her boyfriend potentially faces an expensive course of IV treatment for an MRSA infection. Maha points out that for all of the flaws in our system, there is equality of access. At Your Cervix worries about cost. Here, you would go on Home Care, with RNs visiting you daily.

I’ve worked in both systems. The bottom line is that unless you have gobs of cash and/or a gold-plated health insurance scheme, American health care will suck you dry and spit you out.

I am often severely critical of our health care system for wastefulness and stupidity. As we all should be. Money spent on exorbitant management salaries, consultant’s fees, catered lunches, duplication, inefficiencies and all the rest undermines public trust and confidence in the system, and worse, is money directly taken out of front-line patient care. It is inexcusable.

Yet I would take our system over the American without thinking about it twice. The reason: in terms of crude outcomes, like infant mortality, five-year childhood mortality, life expectancy, cost as a percentage of GDP, access to primary care and the like, the Canadian system consistently outperforms the US. And everyone is covered, without exception. We can argue about the middle and particular cases, like wait times for hip replacements or time to cancer treatment. But we also tend to forget (sometimes too conveniently) that health care in the US is rationed as well. Forty or fifty million people, depending on what statistics you hear, go without insurance, and millions more are grossly underinsured. Here you wait for elective orthopaedic surgery.

The point remains: overall, Canadians are actually pretty healthy. Despite our socialized, horrible, bureaucratized, death-panelized system.

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