TT: Deadly Delays

Welcome to the Thursday Tangent.  If you’re looking for the Wednesday Wandering, just page back and learn where you can hear me giving my first ever podcast.  Then come and join me and Alan as we continue to puzzle through our varied medical systems.

Shining Hope

JANE: Well, Alan, last time we were comparing and contrasting our different medical systems.  We’d just touched on delays for treatment.  You’d made clear that an emergency would be taken at once.  How are things like tests for bumps and lumps dealt with?

ALAN: About ten years ago Robin had a lump. She went to her GP who agreed that yes, it looked like a lump and he arranged an appointment for the first of what proved to be a long series of diagnostic tests.

JANE: Was there much delay in waiting for these tests?

ALAN: No, not really. Nothing happened instantaneously, of course, though perhaps we could have speeded up the process a bit if we’d gone privately.

JANE: Privately?  What do you mean by that?  I thought medicine in New Zealand was socialized.

ALAN: Yes it is, but consultants and specialists all take private patients as well and sometimes this can speed things up a little.

JANE: Okay.  I’m with you, now please, go on.

ALAN: As I said, we had no real incentive to take the private route. The administrative wheels ground along and every so often, over the next two or three months, we found ourselves in a room waiting for an X-ray or a CAT scan or a session with a machine that went ping!

JANE: If you don’t mind, what were the results?

ALAN: Various specialists examined the figures and wrote their reports. The general feeling was that the lump was probably benign. An appointment was made for an operation. Robin was in the theatre for several hours (it was quite an extensive lump) and it did indeed prove to be benign, much to our relief.

And because we went publically, it didn’t cost us a single cent. Everything was paid for by the system.

JANE: I’m so very glad it all came out okay!

Let me give you an example how a similar thing would work here.  First, treatment varies according to your insurance company.  I had one friend who had a lump.  She was repeatedly asked if it caused her pain.  She’s a tough lady and kept saying “no.”  So the lump got bigger and bigger.  Finally, it began inhibiting her ability to use one arm.  Then, at least, various tests were set up.  Fortunately, the lump was benign and so the delays did not put her life at risk.

ALAN: There was nothing like that for us. A lump is a lump and we began the testing regime straight away. There are no special criteria imposed by outside organisations like insurance companies. The only considerations are medical ones.

JANE: That sounds nice.

I will say, our system can react quickly if need arises.  A few years back, Jim had a PSA result that shot up from his test of the year before.  Not only did the doctors contact us promptly, they raced to get him an appointment with a urologist.  The urologist was very responsive.  Everything was explained clearly.  Apparently, an infection can also send the PSA results up.  Since there was no other indication of a tumor, first step was treating as if there was an infection.

We spent a very nervous time, but the PSA results went down (and have stayed down).  And we now know that Jim has a tendency toward “cryptic” infections – that is, infections that do not cause the usual fevers and pain.  This means I now tend to fuss if he gets tired or grumpy without any other apparent cause.  (If you knew Jim personally – as I dearly hope you will someday – you would understand that he is not grumpy by inclination.)

ALAN: I’m glad the system can respond like that. It must have been a huge relief to you both. One question that occurs to me though is whether or not the expenses involved could cause people to postpone treatment?

JANE: Sadly, you’re right.  Sometimes fear of expense does stop people here from either carrying insurance or getting treatment, even if they do have insurance.  We lost a co-worker of Jim’s that way…  Even though she was eligible for insurance, she chose not to carry it.  Then when symptoms came up…  Well, it was a great loss of a talented and warmhearted person.

ALAN: That must be very hard to cope with for everyone involved.

JANE: It really is…  How do you make people take care of themselves?  A recent trend here is various insurance companies (or employers, who often pay part of the cost of insurance as a benefit for employees) providing incentives for healthy living.   Not smoking and losing weight are two of the most common incentive areas, but providing proof of getting regular exercise also may be rewarded.

I recently heard – and this was second hand – that in Scotland it will soon be required for people to use sunscreen because the view is that since medicine is socialized everyone pays the cost of hopefully preventable ailments like skin cancer.

Are there similar programs in place in New Zealand?

ALAN: Not directly – but there are a lot of indirect campaigns with similar aims which seem to work very well. For example, we have one of the highest rates of skin cancer in the world (because we are closer than anyone else to the hole in the ozone layer) and every summer sees the television full of exhortations to cover yourself with sunscreen. “Slip, slop, slap” is the slogan – “Slip on a shirt, Slop on the sunscreen, Slap on a hat.”

And, after lots of negative publicity, smokers are now complete social pariahs; smoking is forbidden in all public areas including pubs and restaurants. It’s even forbidden in prisons!

JANE: Oh, yes…  Smoking is banned in most public areas here, too.  That’s a great relief to me.  When I was a kid, it seemed everyone smoked.  I have come to wonder if my aversion to large gatherings doesn’t date back to conditioning that those gatherings would be full of nasty smoke.

I have two more – or maybe it’s one big interconnected – question to ask, but I’ll save it for next time.