I wanted to share a response I got from my last blogpost (which was on my thoughts on achieving a greater level of justice in healthcare) from a reader who brings up some very excellent points in regards to what some of the goals in healthcare, and in her case, the treatment of cancer, should be. She was very brave to share her story and her thoughts about what she would like from the healthcare system, which is unfortunately not always what the healthcare system provides. Why? Because it is too influenced by forces outside the needs of the patients, and the doctor serving the patient. I also added my response:
This is a great topic that needs to be discussed but seems taboo for some reason. I will give you my thoughts as a person who has stage IV cancer and lots of money has been spent on my behalf so far. The doctors tell me there is no cure for my condition and the cancer will return at some point. I figure they are saying eventually it will kill me. I’m glad I had insurance so far as medical treatment prolonged my life and right now I feel good! However, going through chemotherapy etc. to treat my cancer showed me how awful it feels to be sick. My greatest fear is not dying – it is suffering! It’s been stated that the last 6 months of one’s life is where most of the money gets spent. I imagine during my last 6 months will be plenty of suffering (as there was for my brother,and for my mother and for my father) as the medical profession/politicians don’t give me the option of opting out of this stage of my disease. WHY NOT??? Why can’t I, at my option, say when life gets too miserable to live, give me something to end it? This would save resources for someone else and I wouldn’t have to suffer. I’m not saying everyone needs to go this way. Some people may want to suffer to the bitter end no matter what. But some of us don’t, we should have a medically supervised better option and this would be much less expensive for society – a win win.
On a brighter note, I do think things may be changing. My oncologist told me that she believes cancer is being approached wrong, the emphasis should be on prevention. I think she watched “Forks Over Knives” (I know, it involves vegan propaganda) and it made her think. Hopefully this attitude spreads throughout medicine.
Johannah, thanks for sharing your story. I wish you the best in your cancer fight, and I can tell that you are both brave and honest. In regards to healthcare, and my thoughts for its future improvement, I think it really hinges on taking the heavy 3rd party payer influence out of it, whether it be the government or the private sector. The key is putting the power of choice in the hands of patients. This comes with certain responsibilities, which have to be fulfilled by both the patient and the doctor to work. A patient in your situation can be very desperate to try just about anything, and as a result, healthcare is not similar to other goods in a free market, because a person with stage IV cancer will spend and try just about anything because there is no penalty or harm fiscally to do so. I think to offset this condition, there have to be several things involved: (1) an agreed endpoint, which you say is to provide comfort and reduce suffering, not necessarily prolonging life. Unfortunately, most oncologists/cancer doctors measure the effect of drugs they use by how they prolong life, not by how they make you feel. After all, they use poisons, in essence, which make you feel terrible and sick. (2) Clear understanding of the what the drug or treatment does/how effective it really is. This is where doctors can exert the type of influence that actually helps people if they have the proper incentive to serve the patient’s interest only, and not any outside influence, eg hospitals or protect themselves from litigation, etc. If you are getting paid directly by the patient for the quality of the service that you provide, and not the quantity or the nature of that service, then you as doctor, will view expensive technology or medications in the same light as doing nothing, or providing comfort care, or placing someone on a lifestyle program to help them lose weight and gain metabolic health. We currently do not have that in the system, and rely heavily on technology, which people think is often more useful than lifestyle management, and is certainly more remunerative. It has created an overspecialization in my view, which has made a lot of doctor mere providers of technology. This is not only sad, but I think it’s harmful to health. The only was to really restore and revitalize medicine, in my view, is to give patients the power of choice (through economics and information) and give patient’s access to opinions while making doctors accountable and transparent in terms of both price and value of their treatments. That is, restore the central power of the doctor-patient relationship in health care. To me, that is the only way to make things work. I wish you the best for your health, Johannah, and once again thanks so much for sharing.
As for ‘Forks over Knives,’ I did see the movie, and to be clear, I don’t think a vegan diet is particularly healthy versus an omnivorous diet that is based in whole foods, but they do get the refined sugar and processed food thing right. In my opinion, refined sugar and processed food (and to a great extent grains and the overconsumption of starch) are the key factors in the development of the the diseases that are responsible for the skyrocketing cost in the health care system, ie metabolic syndrome, obesity –>arthritis, diabetes, cardiovascular disease & stroke, cancer, and end of life care. The more I study it, sugar and processed food are the culprits, and so in this sense, the vegans are right. I am willing to acknowledge that. But to say that meat is dangerous and unhealthy, or that an omnivorous diet is not good for you, is something I think the vegans are wrong about.