What is it that is so very different about the two different health care systems? Well first and foremost here in Argentina there is a UNIVERSAL health care system. And when I say universal I mean it. Anyone, man, woman, child, illegal immigrant could go into a hospital and get treated for whatever illness they may be afflicted with on the government. In Argentina, healthcare is a right afforded every person regardless of any other factors. If only everyone in the US would get on this bandwagon. I just don't understand how anyone could think it was okay to deny someone health care simply because of their immigration status or the insurance they had. Seriously as a health care provider didn't you go into thinking you were going to help people and make a difference? [Steps off SoapBox to continue blog post]
Now that I have gone on and on about how wonderful it is that everyone gets care lets talk for a second about quality of care. Much like in the US quality of care if based on the amount of money that you have. The major difference though is in the US, in my opinion, the minimum standards of care seem to be much higher. So while everyone here in Argentina has access to care, I wouldn't necessarily say they have access to high quality care which really does in the grand scheme of things make a HUGE difference in terms of patient outcomes and morbidity and mortality rates.
The next most stunning difference between health care in the US and health care in Argentina is the technology. In the states I feel like every hospital bed has a computer within two maybe three feet of it. All of the diagnostic imaging, blood test results, vital signs, patient history is all located right on the computer, or in some cases the smartphone the doctor is using. Here paper charting is still a way of life. Everything is handwritten. Any sort of diagnostic scans, think MRIs and CAT Scans, or blood analyses are handed to the patient who is then responsible for getting them to the appropriate doctors. I can't even imagine what it would be like in the US if we made patients hang onto their own stuff. It would be a range of ridiculousness from people like me who would forget to bring them to the doctor and people like my mother who would look up stuff on the internet and convince herself she was dying.
Beyond the technology difference there is also a difference in the way the hospital system and patient doctor relationship functions. When I say this I am referring directly to HIPPA. I am amazed at what doctors will say about their patients in front of other patients in the US, but at least they don't use patient names and identifiers when they do it. Having a doctor walk into a consultation of another patient to ask another doctor about new information Joe the construction worker who lost his left foot in the war in the next room just told me XYZ do you think I should change the course of treatment is a regular occurrence here and no one has an issue with it.
The other thing that is greatly different about the doctor-patient relationship in Argentina is sort of a double-edged sword of good and bad. Basically if a doctor is treating a patient the patient's entire family is allowed to be involved in the care. I think from a wellness holistic sense this is a great thing. It is really hard in the United States to communicate personal information about a health topic to family members sometimes who feel because they are not the patient it is not their business. Families here are really involved. I find that family members actually ask more questions of the physicians about the actual diagnosis, what it means, and what the course of treatment is than the patients do. However, all that glitters is not gold. Because the Argentines are so willing to treat an individual patient as a family I have also seen doctors have consultations with patients without the patient there. Literally, a doctor has discussed health care decisions without the patient and only spoken to the loved one of that patient. Then proceeded to give the prescriptions and receipts to that patient. Now I know there are lots of times in the hospital, especially with some geriatric and pediatric populations, that it would be SOOOOOOOO much easier to just talk to the person you know is going to help make the decision anyways, but there is just something about it that doesn't sit quite right with me. I think that no matter if a person is going to undergo some type of treatment or procedure they should be the ones having the conversation with a doctor. The doctor needs to make sure the patient understands what is going to happen regardless of a loved ones feelings. I honestly have not seen this abused here yet, but there is such a high potential for it I can't believe that it is a socially accepted part of medicine here. As I said before it really is a double edge sword. Ultimately you are getting the family oriented care that for a truly holistic approach to healing is necessary for the patient, but sometimes you lose sight of the patient and their actual wants and wishes in doing that.
Maybe the next difference I have seen is because my true hospital experience has really only been in Boston, but it's a difference that stands out either way. Medical research here has NOTHING on the United States. When I say medical research I mean the research doctors do, the research they present, and the research that they read. When I was Singapore I really didn't notice this difference because the university in Singapore emphasized research. But that is not the case here in Argentina. Research takes a major back seat to actual patient care. Honestly there is a huge potential for all kinds of research here in Argentina because of the access to care for all people, but it is not something that is exploited because the country has not yet invested in the idea of research. There are really no hospital research facilities. Publications are read by physicians, but only the very good ones and even they, I think, struggle with understanding many of them because they are not written in Spanish but rather in English. Research is definitely a daunting part of the medical field in the United States. There is the old motto that seems all to true with doctors, especially in Boston, of "Publish or Perish" which just simply does not exist here in Argentina. The oncologists I work for actually held a symposium about kidney cancer last month. It was the first and only type of presentation of a disease, new line treatment options, and other educational materials I have seen to another group of physicians. Working in Boston it seems like every week someone or some team of doctors or nurses is pitching some meeting they're having to discuss their research about [insert weird medical topic here]. I think the lack of research is honestly part of the reason why you see such a difference in the quality of care. Because there is no research in this country about how to carry out treatments for successful patient outcomes there is a gap in the knowledge as to how to make every physician successful at curing patients.
The next thing I am going to talk about is only because I LOVE public health so much, so a lot of you probably won't care about it. Here in Argentina they have social program that work as incentives to get your kids vaccinated. The government actually has mini vaccine clinics in every neighborhood where any vaccine you could think of is available for patients. Patients who are children and follow the government checklist for yearly vaccines and attend school actually are given I think its almost $200 by the government. Not a bad deal for protecting your own health. I do find that there is a great misunderstand about what a vaccine is in this country and therefore in some of the more vulnerable populations, that actually could use certain vaccines, a fear to get vaccinated or get their kids vaccinated. To me though this really isn't any different from the people on the Jenny McCarthy train who don't want to vaccinate their kids from terrible diseases.
I thought a long time about how to end this blog. It just seemed like I could go on forever and ever and ever.....but I won't. Instead I thought I would end with a story that I think illustrates the struggles and benefits of the Argentine health care system perfectly.
The doctor always gives me a quick run down of the patient’s history before they enter the room and what exactly he will be discussing with them today. Well he began telling me the patient’s story and I was preparing myself for the worst, I won’t lie. ”Well she had polio as a child and now she has a weird gait, she’s 45 and this was a diagnosis of stage 2 breast cancer so…” This was my warning. I was expecting the absolute worst to walk through the door. A young woman, tired, worn down, hobbling on some old Tiny Tim crutch, to come through the door. I could not have been more misguided. This woman walked through the door on what looked to be new crutches, dressed nicely, with a decided polio weakness, but her nails were painted and she required absolutely no help sitting down and taking out all of her necessary medical documents. On top of how great she looked, she was the most pleasant patient I think I had seen all day.
I couldn’t do anything but smile. This was the perfect example of how a system can work. How someone with a devastating diagnosis like polio as a child can grow up and be successful. How someone with a complicated medical history is not completely devastated by a cancer diagnosis. This woman was amazing to me. Clearly she had a physical therapist, access to assistive devices, and she was able to catch Stage 2 breast cancer at the age of 45 because of a routine mammogram. I am still blown away. This is what I want for the United States, well without the polio diagnosis (as a future public health nurse I would like to not have that any where in the world).
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