Saturday, July 28, 2007

Cancer Patients, Lost in a Maze of Uneven Care

New York Times:By Denise Grady
Cancer, more than almost any other disease, can be overwhelmingly complicated to treat. Patients are often stunned to learn that they will need not just one doctor, but at least three: a surgeon and specialists in radiation and chemotherapy. Diagnosis and treatment require a seemingly endless stream of appointments. Doctors do not always agree, and patients may find that at the worst time in their lives, when they are ill, frightened and most vulnerable, they also have to seek second opinions on biopsies and therapy, fight with insurers and sort out complex treatment options.

The decisions can be agonizing, in part because the quality of cancer care varies among doctors and hospitals, and it is difficult for even the most educated patients to be sure they are receiving the best treatment. “Let the buyer beware” is harsh advice to give a cancer patient, but it often applies. Excellent care is out there, but people are often on their own to find it. Patients are told they must be their own advocates, but few know where to begin. ...

...When she joined a cancer support group, she recalled, “It was amazing to me the different experiences people were having based on what they could afford or who their provider was. I was able to say, ‘If the provider won’t pay, my family will. I don’t care, I’m going for a second opinion.’ ”

In the support group, it saddened her to hear other patients with advanced disease take the word of a single oncologist, because she believes that if she had done that, she would already be dead. She has come to think that survival may depend on money and access, and, she said, on “your own drive and motivation — are you Type A? — your education and your ability to sort through the medical world and the insurance world terminology.”

This promises to be quite a series.
For all the fuss and negative comment about Michael Moore's narrative techniques, he gets some big things right, as this more conventionally reported piece demonstrates.
Many American patients have their troubles securing a first opinion, let alone a second at a mega-center of their choice. And the disparities in approach, expertise, and outcomes are startling in a field supposedly dominated by science and widespread access to research reports. It would be interesting to know more about comparisons in these regards to the better rated universal systems, such as Canada, France and Germany. (Maybe not Cuba on this one, Michael.)

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