Archive for June 16th, 2009

Different names for the same thing

Americans do medicine differently. I’m not saying better. Just differently.

Sometimes they do it a whole lot better, if you have the money, they seem to do it a whole lot better. Your symptoms will get investigated, and investigated, and investigated some more till they’ve taken so much blood you need a transfusion and you’ve had a camera in every orifice.

You’ve seen House. Well it’s kind of like that. Without the humour, sarcasm and the saving lives.

Sometimes they do the whole medicine thing a lot worse. Like when you don’t have a great deal of money. Which when you look at it is really quite a large number of people.

It is the inequality in the medical care in the USA (or any wholly private system) that offends my little bleeding heart.

On the other hand i’d like to have the resources to stick all the patients through the answer box (also known as the CT scanner…) who i think actually need one.


The medical literature is the source of all these rather academic articles that study fancy new tests and recommend how best to look after your sore toe.

One of my favourites is the case records of the Massachusetts General Hospital (MGH) in the New England Journal of Medicine. These are records of case discussions by groups of erudite doctors who speak very politely to each other (presumably they know they’re being published…) about complicated histories and tests of sick people.

Invariably they go through countless blood tests, consultations and scans till either the patient dies or someone actually gets the diagnosis. And quite often they still die because the disease that is finally diagnosed is so rare that no one actually knows how to treat it.

The most recent I read was from a MGH affiliated hospital in South Africa where the MGH sends its trainees to teach them actual clinical medicine – as opposed to just putting them through an answer box.

The case describes the gradual and slow decline and ultimate death of a young woman with HIV and TB. It is depressingly familiar.

There is then this absurd commentary by renowned experts on what should have been done, and all the fancy tests they could have done to work out was going on. All this with references to the difficulties faced in resource-limited environments.

The sheer gulf between the level of care that that young woman would have got in the MGH compared with what was available in South Africa is staggering.

And perhaps unlike the usual case reports this woman died, not because she had some horrible, rare disease that it took a billion tests to diagnose.

She died because she had a nasty but common and treatable disease in South Africa.



June 2009
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