Friday, September 27, 2013

Good Medicine: A Cultural Perspective

What is good medical care? 

I recently was encouraged to get some tests done due to a pre-existing issue 12 years ago (angioplasty in 2001).   Since I was going to India, I decided that I would wait until I got over there as it would be much cheaper than in the states.  A friend of mine was a bit irritated with my decision, implying that I was risking my health “on the cheap.”  His belief was that the best care is measured by how much you pay; the old adage “you get what you pay for.”  Spend the money and I will get good care was the implication, go cheap and I will likely regret it in the long term.

After our conversation I thought about my time in Kenya.   Africans have the concept that for medicine to really be good it has to taste really bad.  A story is told of some Ethiopian tribesmen who visited a missionary and told them they had malaria.  This missionary wasn’t a doctor, but 40 years ago they thought all foreigners were so they regularly visited this missionary's home asking for medicine.  Lyle told them men to wait outside and in a few minutes he came back with quinine tablets.  He gave each of them three tablets and told them to chew them real slowly.  If you know anything about quinine tablets, they are excruciating bitter.  These Ethiopians did as the missionary suggested and their faces went into contortions, eyes watering as they gasped for air.  After the ordeal, they went back to their village declaring to their friends that they received the best medicine from missionary that day!

The cost of health care in the U.S. is outrageous.  I would suggest bordering on criminal.  Between the insurance and drug companies, doctors and hospitals, a person’s livelihood is one diagnosis away from financial ruin.  Paying more doesn’t mean its better medical care, anymore than bad tasting medicine is better medicine.  

In the end I had the procedure in India in when of the most famous hospitals in the south.  It cost me a fraction of the cost as in the sates.  True, the facilities looked like a WWII ward and they didn’t provide food, soap or a towel.  But the doctor who did the angiogram on me has preformed over 5,000 over his many years in medicine.  All the doctors were as professional as anyone you would find in the states. 

My wife had a heart attack 15 months ago.  Her cardiologist was fine Hindu doctor from India.  I could have had my test taken in the states and let an Indian in America doctor treat me and pay $20K, but instead let a good Indian doctor in India do the honors for less than $1K.  Good medical care is indeed important, but it’s many times a cultural perspective.