This is going to sound...

Paranoid. I don't want to be completely over-the-top-critical-of-the-medical-profession. So let me first acknowledge that doctors and nurses and medical researchers have done a tremendous job of getting us to a place where frankly incredible things can be done to overcome disease. But, as this New Yorker article by Atul Gawande points out, there is an odd dynamic at play in the relationship between doctors and patients that I have never seen in writing before.

I grew up thinking that doctors choose their profession because they have an innate desire to help people. No doubt many do, but I don't think one can call it altruism. Altruism is, economically speaking, irrational. Like buying solar panels for your roof because you believe it's good for the environment, even though it costs you more than buying electricity from the grid. Very few doctors are willing to practise if it doesn't earn them a decent living, and I don't begrudge them that. But if that is so, they have a conflict of interest between their financial desires and the health of their patients. There are many cases where preventive measures - which often cost the patient virtually nothing - would obviate the need for expensive surgery and medications. As I mentioned in this comment a few days ago, healthy diet and lifestyle choices can go a long way. So the question is, why don't doctors just tell us that? Gawande wrote:

Seeing a patient who has had uncomplicated, first-time gallstone pain requires some judgment. A surgeon has to provide reassurance (people are often scared and want to go straight to surgery), some education about gallstone disease and diet, perhaps a prescription for pain; in a few weeks, the surgeon might follow up. But increasingly, I was told, McAllen surgeons simply operate. The patient wasn’t going to moderate her diet, they tell themselves. The pain was just going to come back. And by operating they happen to make an extra seven hundred dollars.

If you want a theory on why doctors are increasingly relying on more expensive treatments than they did in the past, and why there seems to be an inverse relationship between the costs of health care and the health of a population, read the article. With South Africa now investigating a national health insurance system, it's worth considering.

Comments

[Susanna Coleman]

hi Rory

there is some sensible commentary on how much of what you mention (worse health care but it costs more) is due to the insane american health insurance system, their quotas and their doctor's deals with pharmaceutical companies.

luckily, South Africa still hosts practitioners who are not having to earn their medical insurance 28 days a month, work where it's illegal to pay half price on a tablet if they dispense X doses in a month and are also much more inclined to shun surgery when possible. interestingly, much of the drive for surgery is the patients themselves, who also want a quick fix, consistently decline bed rest and insist on a pill.

i'm an optometrist. fortunately the relationship is still: cheap eyecare, cheap sight. but the tension between business and medicine is something that all practitioners have to be conscious of, every day.

it is these forces that have created the great cancer treatment juggernaut. of this, there is much valid criticism, and loss of trust. at a time (a cancer
diagnosis) when one really deserves certainty, we are presented with a vociferous and emotive debate where fear, anger and righteous indignation (from all sides) prevails.

fortunately one can say that South African practitioners
are 1. renowned for their conservative but well informed approach, and 2. often have long periods to wait before new meds are approved, and are thus able to judge based on the success or failure of treatment regimes already instituted in the west.

i suppose i'm trying to say that SA is - being 10 years behind the times - much less likely to reach that terrible state healthcare-wise. patients like you are much less passive, and choose their doctors based on their ability to treat holistically.

we think of you every day, and talk of and to Josh. please post some more photos! love to Lorraine...

best
Susanna (and Hloni)

[Antoinette]

Somehow visiting the blog every few days keeps me connected. Joshua Tree also feels like a tribute to Josh and also can serve to help others who may be on a similar path, especially given the text added on 26 May re the wonders of modern medicine. I believe to just stop the blog would be like saying that with Josh not physically here 'he is no longer' and I do not believe that to be true. I feel he is very much present, we just cannot see him. I feel the blog is also your way of connecting with the world and sharing - good for you and for everyone else who visits it.