What Is A Good Healthcare System?
For openers let me assure you this is not a rant or critique about Obama Care, although parts of this discussion may raise some questions to the reader about certain provisions of that legislation. Instead it is my intention that my observations in this discussion will allow readers to evaluate their existing systems and also review their existing healthcare in terms of its adequacy for their healthcare requirements in the future.
I have analyzed my recent experiences and hope that reviewing them here will cause the reader to evaluate their healthcare situation, both present and future. The healthcare I received in Panama was good, it was what I did not receive that was the problem – the coverage was not wide enough. I did not know that, did not have the knowledge required to pursue treatments, or even be aware of them. It was only after I made a return trip to the U.S. specifically to investigate what I might be missing in my treatment plan, that the medical world opened up. I discovered that the ex-pat living overseas is often making assumptions about the adequacy of the healthcare because they do not have the knowledge and expertise to evaluate adequately. And as changes take place in an individual's health, they are often subtle, though cumulative, and do not trigger a re-evaluation of the adequacy of the care being received until the condition has become a crises.
The answer to the question, "What is a good healthcare system?", is not as simple as it sounds. And, in fact, the answer may not even be an evaluation that can be applied to everyone served by any given system. There are also factors that revolve around breadth, depth and volume of a system that are applicable. But these are all macro types of factors. The real question of importance to most of us is the adequacy of a healthcare system for me and my problems in particular.
I am going to itemize some of my recent experiences with healthcare systems as I continue to fight the battle with Chronic Obstructive Pulmonary Disease, more commonly referred to in its acronym form, COPD. Though I do not feel comfortable with discussing my personal problem with 'the world', I do feel that I can pass on some important lessons-learned to readers. It is my hope that some of these 'discoveries' on my part may save some of you from the same agonies and frustrations. But this discussion is not meant to target only the ex-pats living in Panama or ex-pats living overseas anywhere. I think my experiences will raise questions for those of you considering extensive overseas travel and those considering living overseas in particular. But I feel that some of my 'lessons learned' can be a tool for all people approaching senior status, particularly with the unknowns surrounding the new U.S. healthcare system.
I want to assure my ex-pat friends and acquaintances in Panama (where I spent the last six years) that this article is not intended in any way to be an indictment of the healthcare system in Panama or my experiences with it. In fact, just the opposite is my point. However, as you will see, the healthcare I received there was excellent, while also being inadequate. How is that possible you say? Read on.
As I noted in a previous posting, I began to suspect (finally) that there was something I was missing about both my medical condition and/or the treatment I was receiving from my Panamanian medical professionals. With mans' long history with COPD and the large numbers of people who suffer from it, I became convinced that there had to be something available medically to break the cycle of contract pneumonia, spend 3-5 days in the hospital being treated with strong antibiotics, and then return home to recover for a few days – recover to a lower level of lung health than before I might add. After being hospitalized in Hospital Chiriqui six times for the condition between late December 2012 and the end of June 2013, the suspicion became so strong that I finally made the decision to return to the U.S. and take the fight to COPD.
That decision highlights my first piece of advice - or warning, if you prefer. I stepped off the airplane in Charlotte, N.C., on a Monday evening and was in an ambulance on the way to the hospital at 2pm the next afternoon. I assure you that that is a traumatic way to 'start over'. It also complicates the medical treatment primarily because the medical professionals are in effect gathering information and treating you simultaneously. Needless to say it simplifies the situation if those 'medical history pictures' are already posted.
In my first three days in the hospital I was literally flooded with information about COPD in general and my condition in particular. The information was oriented both towards treating the disease and coping more effectively with its effects on my day-to-day living. We covered best diet and eating rules of thumb, breathing and respiration tricks, new medicines, proper sequencing of taking meds, daily activity sequencing, weather and environment exposure do-es/don’t s, respiratory exercises, and many more to numerous to itemize here – plus I am sure you get the idea. Keep in mind NONE of these kinds of things were ever included in responses from the three pulmonologists I was treated by in Panama – though all three spoke excellent English, and all had received at least a portion of their specialty training in the U.S.
I will give you a specific example of a problem I was not advised on properly, while simultaneously shouldering a good portion of the blame for failing to research on my own. I am old enough to remember when they finally discovered the cure for TB. I remember as a kid people who contracted TB being shipped off to Arizona to allow that climate to make breathing easier. So hot weather helps breathing, particularly for folks with lung diseases – right? And since I like warm weather (and turn blue in air-conditioned spaces), I was happy to leave my windows open 24/7 in my apartment in David. But to be safe I asked two of my pulmonologists in Chiriqui Hospital if improving on the climate would help my condition – thinking maybe to filter the air better by closing the windows and turning on the air. The answer in both cases was 'No', complete with a detailed explanation of the rationale for the response.
You can imagine my surprise when experts here informed me that the constant hot and humid days in David where absolutely not the environment I should have been in. It turns out that those TB patients of old were sent to Arizona because most were living in cold/wet climates – the worst case respiratory situation. Almost any environment was an improvement. Arizona also did not have one of the other breathing problem irritants – humidity (like say David?). My N.C. doctor hastens to add as possible explanation that the Panamanian specialist were responding to my question in terms of 'their world' – e.g., here in Panama. In their mind the question was, "Is this David climate bad, should I be looking at Boquete or some other cool climate?"
Note that my N.C. pulmonologists also cautions that one should NOT be critical of the treatment I received in Panama because, in her opinion, the difference procedures and therapeutic approachs may just be a function of the maturation of the specific medical system in general.
It is a given, is it not, that there are differences even between the system in Panama City and David? The system in David therefore is oriented more towards top-flight treatment of patients admitted to the hospital- at least in certain specialties. The science and practices required to treat the disease in an effort to keep one out of the hospital has less (if very little) priority.
Now that I understand the generality of the term 'medical system', I also have to hasten to add that the statement in the previous paragraph, "The system in Panama is oriented more towards top-flight treatment of patients admitted to the hospital", is true only as it applies to COPD and to the treatment regiment I did/didn't receive. And that is precisely why it is so difficult to evaluate medical systems for the layman, and particularly difficult to appraise the impact on you and your specific medical condition (much less those that may develop in the future).
The Key To The Adequacy of Your Healthcare
The real key to the adequacy of your healthcare system ultimately boils down to YOU – like it are not, you are the key. You must stay informed, ask questions, get smart (AND stay smart) about your health problems and those of your loved ones. We in the U.S. have had this preached to us for years, and modern medicine only continues to get more, not less, complex. I suggest to you that you can make NO assumptions when dealing with a medical system outside the U.S. - Panama or anywhere else.
I will give you the perfect example of what I am talking about and you can them apply the potential for 'surprise' I found to your situation. When I started having real problems with shortness of breath in mid-2012, my Panamanian pulmonologist chose not to increase the dosage of my long-time medication, but to change my medication. He also suggested that when I began to experience discomfort to sit down, get on oxygen, turn up the flow rate and stay quiet for at least 30 minutes.
Imagine my surprise when the pulmonologist here enlightens me to the fact that COPD is such a generic term that different forms require significantly different treatments. My version of the disease (a result of TB damage) dictates that I become seriously winded because I can't get rid of the carbon dioxide, not from shortage of oxygen. The worse thing I can do is turn up the oxygen. In addition the changed medications I had been prescribed were not formulated to target my form of COPD. In addition, it was also important that I get up and get moving around as soon as possible after an attack. How many marks did we miss?
Also note that every pulmonologists' office and hospital ward I have seen in the U.S. have relatively simple electronic test machines that can spotlight one's COPD problem and its projected effects in about three minutes. This affords the medical professionals with the precise information they need to build a treatment plan. I never saw any such equipment in Panama on any of my numerous appointments.
So What Is A Good Healthcare System?
I hope that this information will provoke some of you to take a hard look at your situation and consider as much as possible that into the future. Get smart and stay smart.
I also urge each and every one of you to not put off critical decisions concerning healthcare to 'another day'. I can assure you relocating with a medical problem that has reach a critical stage is not the way to go. Trust me – trying to coordinate settling in your new home from a hospital ward is not the best way to go!
Till Next Time! Pura Vida