The Perfect Medical System

Earlier this evening, just as I needed a break from writing a report for the WSIS Gender Caucus¹, Dr. Persaud came to my rescue through a telephone call and an offer for dinner. We headed to a restaraunt at a nearby hotel, sat down, and ended up talking about medical systems in a very serious way. I have a medical background as a former Navy Corpsman, and he is the Medical Director at St. Joseph Mercy Hospital and a surgeon.

We ended up chatting almost until today - talking about health care in general, about health care in the United States, in Guyana, in Trinidad and Tobago... Dr. Persaud and I are about the same age, and are oddly pessimistic and optimistic about several similar things - plus idealistic when it comes to medicine. He's workes as a surgeon in the United States, and was frustrated by the medical 'system' there, and because of that returned home where he took a drastic pay decrease but feels better about what he does. He loves practicing medicine in Guyana.

Here are some highlights that I can offer instead of a really long post that I've been working on.²

The Spirit of Medicine versus the Tradition of Medicine

One of the things we both adamantly agree on is that in the United States, medicine is more about insurance than saving lives or increasing the quality of life. We've both seen and known people who did not get the best care in the United States because they lacked the right insurance, or their insurance didn't cover something - things which you will unlikely hear about in HMO advertisements, or in advertisements by multinational pharamaceutical companies that want you to 'ask your doctor about medication xyz'. When this junk gets beamed to developing nations, people think that life would be so much better if they could just get those pills - which, of course, they can't unless they are well connected and/or well off.³

What it boils down to, though, is that the tradition of medicine has become one of advertising, paperwork, medical insurance, malpractice insurance and HMOs. Somewhere in there are Patients, Doctors and Nurses - but pound for pound, the paperwork probably outweighs the humans and humanity in medicine in 'developed countries'. A lot of this could be bypassed with modern technologies, but because of legalities and insurance inertia, the medical systems of developing countries face resistance in a return to the focus being on the care of the patient.

The beauty of medicine in the developing world is that lessons can be learned from the inertia of developed world medicine. Patient records can be made accessible to the patients at little or no cost electronically: It is the right of the patient to have a copy of their medical record. Proper medical systems could eliminate the need for insurance, or as much insurance, by cutting costs beforehand so that in regions where cash talks people could continue to pay cash. Affordable medicine, unbloated by too much paper administration and administrative personnel.

Medications should be affordable; preventive medicine should be a focus - Dr. Persaud called it a predictive system. Predict the needs, fulfill them.

The spirit of medicine is to increase the quality of life of patients. The modern tradition in the developed world has seemingly become to increase the quality of life of people who own stock in insurance companies. We spent a lot of time talking about this in various ways, and it was rather eery hearing such similar ideas coming out of someone else's mouth.

The Right of A Human

We both agreed strongly that medical care is not a privilege to people. Medical care is a right. The ability to get medication is not a privilege,it is a right.

Just as no Emergency Department in a hospital should turn away an emergency - neither should a Doctor turn away from a patient that needs care, be it the common cold to breast cancer. So the question we should be asking is not how insurance can pay for this - we should be asking how the patient (remember the patient?) should afford care and medication.

Should hospital care be free? We both agreed it shouldn't be free - but the costs should remain realistic. In Guyana, medical costs are still realistic and it's a race to keep it that way while increasing the quality and population coverage of medical care.

Can it be done? Maybe. We have some ideas. :-) This will become one of the themes around here, I think, because it's one of the unspoken projects that I have been considering for a long time.

Now we have a Doctor and a Developer talking together about such things. That's progress... and in my opinion, has been a long time in coming.

Karma, neh?

¹I'm the Electronic Networking consultant for the Gender Caucus, and have been pretty busy these days with that work, with volunteer work in between, plus correspondence...
² I have some long posts related to the Caribbean coming up, including a blog list, 'intellectual property', and I also have some posts of a more global nature that are finally reaching fruition.
³That could lead into a rant on patent law, but that's another post.