Irish Medical Times article - Good health is a journey not a destination
During my first meeting with my Oncologist he explained what would happen, no questions were left on the table. He told me if I was going to get cancer, Hodgkins was the one to get and Australia was the place to get it; they have the lowest cancer mortality rate in the world.
I was immediately admitted as a public patient and had a lymphadenectomy. I remember the surgeon holding my hand in both of his and saying with a warm smile “I’ll leave a lovely scar”. A public setup, by its nature, strips you of those moments you assume would happen in private. When the young surfer dude in my ward was told there was a tumour in his leg - I was there. On Christmas eve when my cancer diagnosis was confirmed - he was there.
I took my diagnosis and my boogie board and went back to Ireland for chemotherapy. Before I left, my cancer liaison nurse in Australia went through what I could expect to happen next, including specific actions for young female patients such as harvesting of my eggs. Upon my return, unfortunately, my fertility was not preserved, this remains one of the biggest regrets of my life.
I had a good patient experience of healthcare in Australia, what did the other side of the coin have to say. I spoke to Catherine McKenna, a Clinical Nurse Manager who was part of a team that set up a Cardiac Cath Lab in Sydney.
“Everything was just more accessible,” she surmised. “There was a cath lab team available 24/7, this was gold standard treatment for a heart attack in Australia. There was the will to do things, to just get on with it and get them done! A very healthy, positive and progressive environment to work in.”
Australia is renowned for it’s directness, Catherine had stories of doctors sending patients packing for not getting on board with the procedures and care required. I admire this ‘No Plámásing’ policy, but as a patient, along with the poking, prodding and prognosis, we sometimes need a bit of the old plámásing too.
UK
We were all a bit surprised with how successful Britain has been in ‘beating’ Covid. The NHS, Britain's universal healthcare, is taking care of business.
I moved to London in my 20s and developed mouth cancer. Other Irish emigrees were developing accents and hobbies, I thought ‘What would a true hipster do?’ - Get a rare disease you have no risk factors for, then tell people with condescension “It’s actually pronounced ‘SquEEEmous’ Cell Carcinoma”.
I bounced between private and public care for my British cancer (my cancers have nationalities - God help us all). I settled on the NHS, they are significantly slower than private medicine but they have processes, checklists and teams, they spread a wider safety net for the patient. In private care you are dealing with the boss, but if they aren’t listening to you or delivering there is no team of junior doctors and expert nurses to turn to. UK free healthcare is still a jaw dropping experience for any non-Brits; it’s truly remarkable to walk into a GP or a hospital and undergo significant surgery but not pay a red cent on your way out.
At times, as a patient, you can feel the target oriented mechanics of the NHS at work, a patient in A&E must be ‘seen’ within 4 hours, tick, but actually treating the patient may come many many hours later. From talking to NHS staff over the years the message was clear - no one wants to breach a target. In my experience some London GPs kept to the strict 10 minute visit, with only one complaint allowed. It is very difficult for an Irish person to say what is wrong with them in that time, it can take us 10 minutes to get past the initial ‘hellos’.
Overall the NHS have looked after me well. I was ‘lucky’ in the sense that I was an unusual case with a repetitive problem that put me firmly on my Consultant’s radar. I salute the NHS but I can appreciate there is no such thing as a free ride, it is weighed down with long waiting lists, over stretched resources, underfunded and inequitable services. Covid has exposed many problems with healthcare all over the world and Britain (despite its speedy rollout) is not immune.
USA
As a career patient when I moved to America in my 30s I had to get to grips with their healthcare system pretty quickly. There was also the pesky business of finding a pre cancerous tumour in my pancreas and having a partial pancreatectomy and splenectomy.
I soon realized the insurance companies run the show. If you can afford insurance and get ‘in network’ with a good Primary Care Physician and hospital, you are integrated. I could see my Cardiologist on a Monday, my Oncologist on a Tuesday, and then most of their comments, reports, and test results would largely be up on the computer system the same day. I could see my PCP and they would have everything in front of them on the computer screen - also accessible to me through an app.
I had one doctor who worked in a rival hospital and fell ‘out of network’. The insurers still covered a good amount of the co-pay but it was a bureaucratic nightmare, so for admin reasons I stopped seeing her. She was monitoring me for cancer, I am just damn lucky I stayed in remission.
My pancreas surgery was deemed very complex, two surgeons passed on it and I thought I was running out of options until I got a call that the hospital’s hot shot surgeon was back from field duty in Iraq (?) and was confident he could handle my case. When I met with him he definitely had a God complex and more than a passing resemblance to Ares. For the 10 minute consultation he charged $800. Thankfully I had insurance, how are people without it expected to survive?
In America the tech is there, treatment options are plentiful, and the patient sees themselves as a partner in the interactions, (whether it's called for or not). But here is where my heart breaks - on a vacation through California’s mojave desert we stayed in a small Inn run by a man in his 80s, he was frail and could barely turn the key in the door, he said he had recently come out of retirement because his wife was gravely ill and he couldn’t afford her medical bills. It’s just wrong.
Ireland
Having lived abroad for many years I returned home with my family to roost and welcome in my latest illness of heart failure. I can honestly say what I’ve always suspected, the Irish are a particular kind of people. They say the Inuits have 400 words for snow, the Irish have one word that has 400 meanings - “grand”. I wouldn’t be surprised if medical degrees in Irish universities now have a ‘Grand’ module. When a young doctor in Australia first told me I had cancer, he was more nervous than me. After a minute of silence he asked me if I was ok, I replied “Me? Oh sure, I’m grand”. Doctors in Ireland understand the Irish psyche, they know ‘grand’ rarely means that you are ok.
The role of an Irish doctor is more than that of a medic, a consultation can often involve coaxing, coaching and calming (and that’s just with me as a patient!). For a certain Irish generation going to the doctors is a day out, put on your Sunday best and get your stories straight. For some people it might be the only conversation they have that week. Irish people are famously very good at talking about things or around things, but what are we actually saying?
I am glad I have experienced healthcare abroad, I was in the right places at the right time. I also feel there are many lessons we could adopt into our own imperfect system. However, with chronic heart disease I now need more than luck on my side, I need to be understood. I’m back home amongst my people, treated by those who get me, supported by family and friends who know me.
And for now... I’m doing grand.
Original article found here - Good health is a journey, not a destination
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