Friday, May 05, 2006


Recent news that British are healthier than Americans while enjoying the same rates of smoking, obesity, and lack of excercise seem to implicate the US health system. That may be. But I'd say there's a lot more to it than that. First of all, these are two different cultures (and for proof of that, watch a Benny Hill episode), so there are literally thousands of differences. While the British may smoke more, they certainly walk more. This morning, I walked to my car, drove to work, and have essentially been sitting ever since. In the UK, that is unlikely to happen.

But to move onto health care. What a difference prevention makes! UK's got it. We don't. End of story. My medical school friends who are in primary care make 6 figures by small margins. Those in specialties can make more than double that, while working about the same.

Here's how it works. Two cases.

Mrs. Peach is 25, she establishes care with a primary care doctor to treat her thyroid condition. That doctor does so. He also recommends she stop smoking, which she does. He recommends she stay healthy, which she does, eating whole grains, avoiding trans fats, and excercising. She goes through life. At 40 she needs a gall bladder surgery and at 50 a thyroid nodule comes out. Whe has carpal tunnel at 55. At 85 she becomes forgetful and is on three pills: one vitamin, one thyroid pill, and an aspirin. She dies in her sleep at the age of 88. The cause of death is deemed cardiac, but no lesions are discovered at autopsy. Most doctors would say off the record that she died of old age (but you can't put that on the paper).

Mrs. Drain is 25, but has no health insurance, so the thyroid condition goes without detection while Mrs. Drain becomes obese. Mrs. Drain smokes and never considers the effects. Mrs. Drain walks when forced. Her obesity literally squeezes a back disk inot her spine and she requires a surgery and another one to correct the first. Her knees start to go, further preventing her from walking. At 40 she needs a gall bladder, and at that time diabetes is discovered. Because her habits are established by then, weight loss is impossible. She goes on meds to control the diabetes. At her next visit, he doctor cannot feel a pulse, so she is referred to surgery. Multiple stents are placed through her femoral artery to open it up. Now deemed a high risk vasculopath, Mrs. Drain is placed on 8 different drugs, which make her tired and she is unable to work. She goes on medical disability full time by the age of 53. Her first heart attack occurs by 57, requiring further stents, and she is blind by 60 from the poorly controled diabetes. Retinal surgery with lasers is of marginal benefit. At the age of 63 she has another heart attack. She is brought into the hospital without a blood pressure and coded for 15 minutes. During this time, her brain received little blood flow and massive cerebral injury occured. After spending the next 4 days in an ICU, she is deemed to have little chance of a functional neurologic outcome. For the first time in more than 20 years her blood glucose reaches normal levels. Nevertheless, the breathing tube is withdrawn and she dies about an hour later.

The differences between Mrs. Peach and Mrs. Drain are myriad, but I'd like to focus your attention on their economic differences. Nothing more need be said.


Blogger marybishop said... seems embarassingly simple to enhance the lives of the living and ease the lives of the dying.

But for some reason, we don't have that here and they've got that there...(there could be many places including the UK)

And, it's not just the poor people who don't have medical insurance...I know. In the past 10 years we've had numerous stints of no insurance...medical or dental and have had to settle for catastrophic insurance until we could chip in the ten grand it would take to insure our family.

ps(Husband is an expert in air pollution control -- no jobs in that field)
pss (He's now working in "finance" and has medical coverage and good coverage for a change.)


8:25 PM  
Blogger Doc NOS said...

But we never do the simple and easy things. Especially in medicine. We'd rather do a fancy new procedure of unclear benefit.

6:50 PM  
Blogger marybishop said...

Everyone is always dying to try out the new just about any field.

What ever happened to Occam's razor?

10:24 PM  
Blogger acumamakiki said...

Everyone would rather have a pill or something seen as the easy way of doing things (even though the healthier lifestyle is SO much easier).

1:54 PM  
Blogger Ern said...

People don't seem to understand that we're still paying for medical care for the uninsured. It just comes out of taxpayer money and costs more since they have had no preventive care and everything is severe or end-stage or an emergency.

6:06 PM  
Blogger Doc NOS said...

Ern, this is exactly correct. As long as these costs stay hidden, then it gets ignored. Same thing with preventative medicine - try to avoid going into primary care if you want to stay sane and fiscally OK - unless you love it in which case read Of Human Bondage.

Acumamakiki, totally. People get up some nerve sometimes to ask me how I stay in shape: I workout and eat healthy. They never like that answer.

MB, I just got an I-pod. Great toy, as it was when I got one called a Walkman.

7:59 PM  
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