The Medical Merry-Go-Round

Let me preface this with "I love my medical plan." I do. It's somewhat reminiscent of California's Kaiser Plan, with all the attendant woes of multiple referrals, long waits, etc. but the Meuhedet clinic up the street from me is staffed by wonderful, helpful people who have tried to make my life easier.

However....

It's not Blue Cross. But it's also not $1000/month for a family of three (that was our share--my employer paid the other half) and going up every year. So I'm really NOT complaining....

However....

I mentioned before that Yossi has a problem with his back. His doctor declined to offer physical therapy when they both sat down and talked about this. Yossi suggested PT. "What, you have a medical degree now?" the doctor asked, smiling. Pills were the doctor's solution, and then "we'll see how we're doing in another six weeks."

Who's this "we" he's talking about? The doc isn't the one with the bad back!

Sure enough, 24 hours later, in excruciating pain, Yossi saw the doctor again who then reversed himself and said, "I think we should try physical therapy immediately." Yossi was brought up correctly. He said 'thank you, Doctor,' and took his referral to the physical therapist....unlike me, who is inclined to snarl at medical professionals. I would've asked him what Cracker Jack box he pulled his medical degree out of, and why didn't you listen to me in the first place? Lawyers are NOT impressed by doctors.

So through this I discovered the Israeli medical profession's definition of "immediately." It means next month. That's right -- the first available appointment for PT is in July.

Nor is this unusual. We have friends nearby, a couple, who have been doing their own dance with their kupat cholim. The husband has had a prior heart attack. He's on blood-thinners and other medication to keep down cholesterol and prevent heart attacks. This year, he developed an irregular heart beat which was also very, very rapid. He was hospitalized, and went through some kind of electroshock procedure which restored the heartbeat to normal. Questions about the root cause of this sudden phenomena were shrugged off. The wife's suggestion that he have an angiogram was brushed aside.

Two weeks ago, the rapid, irregular heartbeat appears again.

Is he hospitalized? No.

He is summoned to do test after test after test for two days, returning home each night both exhausted and worried. This is not a good state for a man who has heart problems. It's also not a good state for his wife, who is then awake all night and exhausted from worry. She's also in a state of near-panic because Doctor said, "Call me," for the test results and she did--and Doctor isn't answering his phone or returning her messages.

After three days of telephoning, she finally reaches the doctor. Doctor tells her that the results "aren't in the computer yet."

Maybe Doctor could send someone downstairs (since we all know Doctor won't walk downstairs himself) to expedite putting the results in the computer? That Someone might even be able to get a copy of the results to bring back upstairs to Doctor!

Finally, Doctor announces that the husband has a blockage and the hospital needs to do first, an angiogram, and most probably an angioplasty.

Fine. At least there is now an identifiable problem with a solution.

Following instructions to the letter, the husband reports to the hospital for the pre-procedure work-ups. He and his wife were told he would go home following this -- but no, he was hospitalized instead. So his wife goes home, worries about why the doctor decided to keep her husband overnight, and comes back to the hospital the next morning. He's all prepped for the procedure when suddenly his doctor appears and says, "You're taking XXX medication (a blood thinner)!"

No s**t, Sherlock -- you were the one who prescribed it in the first place.

Doctor goes on to explain that they can't possibly do this procedure while the patient in on blood-thinners, and he needs to be off the medication for a specific number of days before they can do proceed. All very medically proper, and no doubt life-saving but maybe a closer review of your patient's file would have suggested that (1) you tell him first to quit the bloodthinners and (2) schedule the procedure the requisite number of days later instead of making this family run in and out of the hospital repeatedly.

Maybe Doctor should have listened to the patient's wife, who told him months ago that her husband needed an angiogram....she would probably have gotten Yossi's answer: "What, you have a medical degree now?"

I'm not complaining...really. I just hate watching my friends deal with bureaucratic silliness and institutional incompetence.

On the other hand, the world of Israeli medicine is overall quite positive. This, just in from Israel 21c :

Israeli-Californian research: Star Trek-like scanner could spot signs of cancer

By correlating images of cancerous liver tissue with gene expression patterns, a bi-national research team including a computational biologist from Israel's Weizmann Institute of Science, a genomics expert from Stanford, and a radiologist at the University of California, San Diego (UCSD) School of Medicine has developed tools that may some day allow physicians to view a CT image of a cancer tumor and discern its genetic activity. "In almost every episode of Star Trek,' there is a device called a tricorder, which they used noninvasively to scan living or nonliving matter to determine its molecular makeup," said Chang. "Something like that would be very, very useful." In real life, this approach would avoid the pain and risk of infection and bleeding from a biopsy and would not destroy tissue, so the same site could be tested again and again.

As well as this, something I would definitely like to see on the shelves in my lifetime:

Israeli student develops novel drug that mimics feeling of 'fullness'

A Hebrew University of Jerusalem doctoral student has developed an innovative drug that gives people the feeling of satiety. Yaniv Linde, a 32-year-old student of Prof. Chaim Gilon in the department of organic chemistry, mimicked the activity of the naturally occurring hormone called aMSH. This hormone is naturally excreted during eating and binds to a receptor in the brain called MC4R. When this "communication" occurs on a substantial level, the brain sends out a signal that one feels "full." Linde and colleagues synthesized a peptide (a compound linking two or more amino acids) that can serve as an analog to the naturally occurring aMSH hormone. They were able to demonstrate that their peptide, which they call BL-3020, displayed good metabolic stability to intestinal enzymes when swallowed, and that it was able to cross the intestinal wall and gain access into the bloodstream. Once in the blood, it could make its way to the MC4R receptor and "close the circuit" to send out the "full" signal. The result is that a person seriously wishing to overcome obesity could take this compound orally in order to curb his appetite and lose weight naturally. In experiments with mice, it was shown that a single oral administration of BL-3020 led to reduced consumption over a period of 24 hours. Over a 12-day period of daily dosages, the mice weighed 40 percent less than the average for mice of their size and age that did not get the compound. (Judy Siegel-Itzkovich June 07, 2007)

With stuff like this being developed by Israelis, I guess I can be a bit more optimistic about the future of medicine here.....now, if we can just get the doctors to work on the bedside manner a bit more and actually LISTEN to their patients...after all, this is the country that developed the cell phone because the waiting list for a landline was five years. Maybe some genius will develop a pill that makes doctors listen to those of us who admittedly don't have medical degrees but DO own the bodies you're working on.