There’s a reason people pay for medical evacuation insurance when they travel overseas.
Why are some assuming NorthernMom’s doc didn’t apply his med knowledge?
She may have documented in a way that answered all the questions he would have asked. We don’t know that he skipped inspecting her wrist, etc. Only that she did get the shot she needed.
Far be it for me to defend the US system BUT my American PCP believed me when I said I thought I had lupus and ran an ANA test and away we went. That’s why I was dx’ed so quickly when others take years and years to get dx’ed.
@Igloo Exactly. In countries with socialized medicine malpractice awards are strictly limited.
My doctors do speak with and listen to me (or I sever the relationship). They have served me well and treated me properly. All of my docs were educated in the US, tho my kids were seen by an allergist educated outside of the US. He was excellent and moved to the Midwest and recently moved back to India where he has set up a major allergy clinic.
But you would be paying 15% sales tax and high income tax too.
I pay for medical evacuation insurance, if something happens in Namibia, or Laos, or USA, they will evacuate me to home (which is not USA).
I don’t see a big mystery, the study shows that outcomes are the basically the same (11.2 vs 11.6% or whatever is a meaningless difference). Foreigners are not more or less stupid than Americans, and their medical schools are not better or worse at delivering basic medical knowledge to the student.
If you want the best medical care in the world and you have plenty money, you will go to USA … or UK, or Germany, or Switzerland, or France, etc., usually depending on the exact problem. Personally, if I need a liver transplant, I’m having it done in China.
I think you are fine in any, if not most, 1st world countries as @sorghum states. I’m sure their medical schools are as top notch as ours. Poorer countries may have wonderful docs, but not up to par medical equipment or medicines. I wouldn’t want any surgeries there and would want to be sent home.
I want my doc to take me seriously, but run their own tests they see fit.
What I do sometimes is arm myself with knowledge I’ve acquired. I’ll tell the doc all my symptoms. If they start diagnosing or telling me things I’ve read…especially detailed stuff, I have more confidence in them.
To further muddy the waters, care from NPs is equal to or greater than care from MDs. I am not sure if it is because NPs are overwhelmingly female.
@marvin100 is right, too about where many FMGs (which is how we often refer to foreign-born med grads) practice-- in underserved areas, both during training and after. I’m sure many here have read “Cutting for Stone”. Remember how Verghese describes his residency in the ‘wrong side of the tracks’ teaching hospital in NYC? Very accurate. There are lots of residency slots in NYC, and they have an interesting population there of great American kids who are New Yorkers and would never train anywhere else, and FMGs who can get residency slots there because of the need. The teaching hospitals imo are all pretty great, but the atmosphere can be very different in a hospital that serves the wealthy or middle class and the ones that serve the indigent and the rest of the people. And the patient populations differ greatly as well. More chronic illness, less access to care, etc. This is also true in rural areas of the US where it’s hard to find docs to move there (though these areas aren’t always poor areas, just smaller towns and cities. I practiced in one in WI. There were lots of American-trained PCPs but several specialists were FMGs).
A small price to pay for what we get. And the HST is 13%, not 15.
I’d happily pay far higher income taxes to be free of the insurance conundrums in this country. To be free of worry as to whether my D will have the sort of insurance to pay for her epi pens is worth a great deal. As is potentially retiring prior to age 65 without the insurance dwarfing all other concerns.
Abraham Verghese wrote some non fiction books prior to Cutting for Stone. My favorite is My Own Country, about treating the AIDS crisis in the rural south. It is a book I think back on often that explores some of the ethical issues for a foreign practitioner in a small town area.
I work with foreign as well as domestically trained hospitalists. Some are brilliant, some less so, training aside.
The sad thing is that public spending on health care in the US ($4,197 per person in 2013) is higher than public spending on health care in Canada ($3,074 per person in 2013). Of course, since US public health care spending covers far fewer people than in Canada, private spending is much higher in the US ($4,516 versus $1,277 per person in 2013).
http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective (exhibit 2)
I’ve heard some horror stories about health care in other countries. One friend had to beg and plead with a doctor in Rome to just draw some blood for a Hepatitis test, which came back positive. Then because the hospital had no alcohol to swab the area before the needle went in, she pulled some perfume out of her purse to use to clean the area. Perfume is mostly alcohol. Why the Rome hospital didn’t have simple alcohol is beyond me.
Another friend’s son got into an accident in Thailand resulting in a bad fracture of his leg. An operation was done in Thailand but the bone became infected and he had to be rushed back here in order to save his leg. But because of the poor care there, he needed bone grafts, skin grafts and had to be in a wheelchair for a year.
I know anecdotes are not data and YMMV, but…
There is a reason, as I said before, why Americans who travel abroad want medical evacuation insurance. Especially when the illness or accident is serious.
(This is a digression from FMGs practicing here. They all need to do the USMLE and do US residencies before they can practice in the US, so at least their last years of training are US based).
On the other hand, my dad lived and died in Thailand. The medical care I saw in Bangkok was excellent. Most of the specialists were products of American residencies. An infection and bad care can happen here as well, necessitating transfer to a regional hospital.
I get evacuation insurance when traveling so as to return to my home and the supports that are in place, as well as my health insurance, not because I am afraid of medical care abroad. It is also helpful to be in a familiar culture, with your primary language when stressful events occur.
I had an operation in Thailand and have had several in the US and I would not differentiate except price was MUCH less in Thailand. I am sure some parts of Thailand do not have great health care but there are some excellent hospitals in Bangkok.
Re @TatinG comments, I know of several folks who had operations in the US who would up with deadly infections…it can happen anywhere…
The study said the average cost per admission was $1145. Does this seem really low to anyone else? A single MRI can be more than that.
I’d pay 5x what I do in taxes right now in order to never, ever have to worry about being uninsured ever again.
For me, being uninsured = death or permanent disability. So yes, it keeps me up at night and I’d happily pay much more to sleep easier.
Physician here. All foreign medical school grads still do American residencies. Different places have different ideas about what to do. The country of origin means far less than the residency program trained at. As does the specialty trained in. One reason to be airlifted home is to be HOME.
btw- easy for those who have plenty of money to be willing to raise taxes to pay for things. Difficult for those in the middle. Tax the rich more, and be thankful you earn enough to be in that category…
The vast majority of ailments people seek treatment for probably fall into a few neat categories with standard treatment protocols. Any physician, regardless of educational background, should be able to appropriately treat most ailments with a few years of experience. What is rare is to find someone who is a skilled diagnostician for problems that are “outside the box”. The NYT sometimes runs a column called Think Like a Doctor in which a case study is presented and people try to figure out the disease. Usually the case study patient has been to several highly regarded physicians and research hospitals before their problem is solved, often by someone not affiliated with an elite medical center. It is surprising how few ostensibly well trained and experienced physicians are excellent diagnosticians. The NYT recently ran this story about a med student stricken by a mysterious illness that he ended up diagnosing himself. Not only did he diagnose himself, he discovered what appears to be an effective and specific treatment for his disease.
https://www.nytimes.com/2017/02/04/business/his-doctors-were-stumped-then-he-took-over.html?_r=0