Your life in their paper bag
Med students, Sundays and insurance: a dangerous cocktail
Image: Rama, Public domain, via Wikimedia Commons
This blog post comes at you from the Netherlands, from the home of a friend of 20 years’ standing. The friend, however, is not here. He is 20 kilometres distant. One kilometre for every year of our acquaintance. He’s in hospital and he’s very ill.
On Sunday, he felt unwell and called for assistance from some neighbours. They called a doctor, because without a doctor you can’t go to hospital. That’s the rule. Hospitals have been swamped in the past with unnecessary, so-called emergencies. At a time when a lot of national sickness insurance schemes are denying the right for patients to seek a second opinion, as far as hospitalisation is concerned, these schemes demand, if not a second, then a first opinion. Once the doctors had gone, the neighbours called an ambulance. Usually, it should have been the doctors who did that, but their diagnosis didn’t permit.
The first opinion that my friend was given, on Sunday, was very similar to a first opinion that was given to my husband one week after our wedding, and hearing such a similar tale now, even after 17 years, has me reaching for sedatives and, possibly, a third opinion.
My husband, I opined, after we’d celebrated our union in our own home, somehow miraculously accommodating 42 people in our living room at a set-table, self-service meal with separate bar and the smallest kitchen in which the caterer had ever prepared such a collation—in her own words—lay in bed recovering whilst I did the entire mountain—no exaggeration—of washing-up on my tod. By the following Sunday, his bed-ridden state was almost at the point of obliging me to wish him a good-riddance state, so off I dragged him to the A&E at the University Hospital in Brussels. After a mere three hours, he was taken to radiology and, presently, the snapshots were available for approval and framing. We were seen by Dr Aerts and, if you speak Dutch, that’s a bit of a joke (arts is a Dutch word for a doctor). It would eventually transpire that Dr Aerts was indeed a bit of a joke.
Dr Aerts sent us home holding, I believe literally, a paper bag. My newly-wed other half was hyperventilating and there was nothing to see on the X-rays.
The following Thursday, we’d planned to cross the channel to England, and, since we needed to pass that hospital on the way to the coast, I called a consultant I knew there.
“What’s his name?” she enquired. I told her. “How come?” I asked.
“I’m at the computer right now, looking up his file. I can see the X-rays. What did the doctor tell you?”
“They’re utterly normal.”
“Graham, these X-rays are anything but normal. Get him here, now. I’ll hold a nurse back at blood samples and tell the lab we need an emergency analysis. How soon can you get here?”
“Give me thirty minutes.”
“Break the limit.”
Sven was taken straight into blood sampling, the results were there within 20 minutes.
“How much longer do you think it’ll take?” I asked, “We have a ferry to catch, to England.”
“You,” Petra pointed, “can go to England.” Her digit changed direction. “He, on the other hand, is staying here. I’m hospitalising him in cardiology. He can go, of course, if he wants. But he’ll come back in a wooden box.”
The diagnosis of hyperventilation, it seems, had been erroneous.
Sven was in hospital for another two months. The first week was spent getting his sock size back down to normal. I played host to a succession of family members who came to cheer him up and express concern, and I used their presence, upon Sven’s discharge, to hold them to a vague promise that’d been made to help with redecorating the lounge, denuded of furniture and all as it was. It’s not been done again since. But that’s not to say I need to get married again.
My Dutch friend, it has transpired, fell victim to a similar, lackadaisical approach to the art of medicine, and a truth has emerged from our joint experiences: only guinea pigs fall ill on Sundays. Because Sundays are for home and togetherness, and that means that doctors are all ensconced with their families and the people who’re diagnosing hyperventilation are generally going to be 4th year medical students.
One time in emergency with Sven at a later date in another hospital, I made the usual casual enquiry as to “Who am I speaking to?”: “Thank you, Doctor …?” Instead of her name (at least, I assume it wasn’t her name), she completed my sentence with, “Bijna”—nearly. She would be evermore known as Dr Bijna. But at least she didn’t diagnose hyperventilation.
I don’t know if hyperventilation is a standard diagnosis by all those who have not yet taken their finals. Correction: hyperventilation is not a standard diagnosis by those who have not yet taken their finals, because I was myself a medical final exam question for the re-sits one week after I started my law course, having contracted chicken pox from my roommate in halls, and not one of the successful students that day diagnosed the red spots covering my body like I’d been sprayed with raspberry jam as being caused by hyperventilation.
I called the consultant I knew afterwards. “Anyone can make a mistake. But no one should make a mistake like this and not be given the opportunity to learn from it.” “No,” she replied, “I’ll see to that.”
We later took her to lunch. After all, the woman had saved our lives. Both, in fact.
Sven’s problem resided in a weak heart chamber. Instead of 60% performance, he was barely chugging along with 6%. Where exactly my Dutch friend’s problem lies is in a bacterial infection with a Japanese name. It’s not pleasant, but could be picked up by anyone. Except a Sunday doctor, that is. There were even two of them.
My buddy’s on treatment for a long-term bone illness. His insurer tumbled onto a cheaper alternative medicine and told him “Switch, or we won’t insure you any more.”
Neither he nor I (and a final analysis by his hospital physicians may not either) know whether switching his medication has caused or exacerbated the problem for which he was hospitalised on Sunday. He’d lost 13 kilos of body weight in three weeks, so it was serious. But, can an insurer do that: effectively make a diagnosis and prescribe medication off their own bat? As it were, the very second opinion that so many insurers are reluctant themselves to allow for their insured? The physicians who work for insurers are coming under scrutiny. For block denying cover in the Cigna scandal in the US; and, if the US insurance industry sneezes, I have little doubt but that the rest of the world’s … will … hyperventilate.
I feel a bout of hyperventilation coming on right now.