Mind Over Miller: It's not perfect, but it's the best we can do


It is inevitable that the United States will eventually have socialized medicine, as many other industrialized capitalist nations already have.

It is inevitable that the United States will eventually have socialized medicine, as many other industrialized capitalist nations already have. We have partially socialized medicine now, and the inadequacies of the medical insurance industry, the faulty HMO services, the large uninsured population, and the frequent failings of the medical profession all encourage the voting populace to presume that a socialized system would be better.

Alas, that is not true. I am opposed to socialized medicine, and my opposition is based on personal experience. I am not talking about the time I lay sick and feverish with dysentery in a U.S. Army hospital when a nurse entered the ward and ordered, "Everybody up and mop the floors!"

Nor am I talking about the time I was a student in Colorado, and a school physician injected my shoulder bursa with ACTH. "They told us in pharmacology that the action of ACTH is systemic," I meekly offered, "and that corticosteroids should be used for localized lesions like a bursitis."

The physician glared and said, "Nonsense. I use ACTH in bursitis all the time!"

It didn't matter because I didn't have bursitis. I had a torn rotator cuff.

No, what turned me against socialized medicine was personal experience in England, surely one of the most civilized nations, and one that I as a confirmed Anglophile have always admired. British courage, humanitarianism, and civility are unmatched, but my experience with its medical system has made me keenly aware that a private-enterprise system is a more powerful motivating force.

My first experience with socialized medicine in England occurred when my son was 16 and I was a scheduled speaker at the British Veterinary Congress. It was two weeks before the congress, and we were driving around England. (We had just visited with James Herriot in Yorkshire.) As we explored the lovely English countryside, we would spend the nights at bed and breakfasts along the way. Usually energetic, my son kept complaining that he was "so sleepy" and "so tired." In retrospect, he was probably going through a teenage growth spurt. But at the time, I was worried about things such as leukemia, and I knew I'd feel better if he had a complete blood count. At breakfast one morning, I expressed my concern about my son to our hostess, who was a young mother with three children.

"Oh yes," she empathized. "I can call my pediatrician, if you wish, and explain that you are a foreign tourist, and, perhaps, he'd work you in. Or you can go to the local hospital, and your son can be seen there."

Not wanting to disturb a busy practitioner's schedule, I decided to try the hospital.

"However," said our hostess, "all laboratory work is sent to Manchester, and it takes four days to get the results."

"A CBC is just a blood count," I explained. "It only takes a few minutes to run one, so we can wait for the results."

"No," she insisted, "all lab work goes to Manchester and takes four days."

"You see," I patiently explained, "I'm a veterinarian. We run a CBC while the patient is on the examination table. It's a quick test, and I'm sure it won't need to go to Manchester."

"And I'm a registered nurse," she retorted, "and I'm telling you that a CBC goes to Manchester, and it takes four days!"

She was correct, of course, and this was my first glimpse of socialized medicine's shortcomings.

Years later, when I was in England for another congress in Harrogate, I picked up a London newspaper and looked at the front-page headline. It read, "Breast cancer patients will no longer have to wait longer than eight weeks for surgery." What a concept!

The next day my wife complained of photophobia. Her eyes looked normal, but they became so sensitive to light that even the candles on the dinner table caused her discomfort. Fears of glaucoma flashed through my mind, and we would not be home for another two weeks.

Because it would be impossible to see an ophthalmologist on such short notice, we went to a local emergency room instead. A nice, young physician checked my wife's eyes with a flashlight and an ophthalmoscope, but as he fumbled with the latter, I could tell eye treatment was beyond his expertise.

"Well," he said, "I can't see anything wrong, but I must be honest and tell you I am a general practitioner, and, frankly, I don't know much about eyes." I asked if it were possible to do tonometry to rule out glaucoma. He said he'd write a referral for us to see a specialist at Leeds where they had a teaching hospital.

The next day, I drove my wife to Leeds, a half hour away. We registered and sat in a waiting room jammed with patients. In front of us, a comatose 6-year-old boy lay on the bench, his head on his mother's lap. In the hall, several hospital staff members sipped tea, talked, and laughed. On the walls, posted in several places, was an unforgettable message: "Profanity and displays of temper will not be tolerated, and offenders will be expelled from the hospital." I confess that I cannot remember the exact wording on the signs, but this conveys the message.

Hours went by. The comatose boy had not yet been seen when we were called. A nurse asked to see our referral slip. When we showed it to her, she said, "This is from Harrogate. You must have a referral from a general practitioner in Leeds." A G.P. was duly found, and the flashlight-and-ophthalmoscope routine was repeated. Always pleasant and gracious, the doctor explained that a specialist must see all eye problems, and we were given an appointment for the next day. So we again drove to Leeds. This time a friendly and personable young resident examined Debby's eyes for half an hour. Finally he explained, "I'm a resident. I see a growth in your wife's eye that I am concerned about, so a senior ophthalmologist will look at her."

Filled with concern that my wife had an intraocular tumor—the tonometry examination results were normal, so my worry about glaucoma was relieved—we waited another two hours. Finally, an ophthalmologist did a careful examination. Not realizing that I understood the entire conversation, the ophthalmologist explained to the resident that the abnormality was an insignificant anomaly on the choroid, and a minor meibomian gland inflammation was causing the photophobia. They then explained to me, in layman's terms, what was wrong. I never did tell them my profession, but I asked what we should do. I swear to this: We were advised to buy some baby shampoo, the "nonburning" kind, and put one drop, full strength, in each eye every eight hours. Although filled with doubt, we bought the shampoo and followed orders. My wife stopped screaming after I irrigated her eyes with water and told me she would prefer blindness.

When we returned to our hotel in Harrogate, I telephoned our ophthalmologist in the United States and told him all I had done. After a long silence, he asked if I had any ophthalmic ointment. "Yes," I said, "I have some gentamicin ointment."

"Good," he said. "Use it b.i.d. When do you get home?"

"Two weeks from today," I answered, "on Sunday."

"I'll see your wife at 8:30 Monday morning," he said. "Enjoy England."

Now it is unfair to make a judgment based on two or three incidents, as I have related, and I didn't. What convinced me to forever oppose socialized medicine was those signs in the waiting room. In a society in which civility, politeness, and good manners are unmatched, the signs are evidence of an inadequate medical system.

No medical system will ever be completely satisfactory; the cost of modern medical technology is too dear, and human error is too common. Add to this the growing attitude that good medical care is a right (despite the fact that it is absolutely clear our constitution provides no material rights), and frequent dissatisfaction is guaranteed.

There will always be people who cannot afford insurance, indifferent people who can afford it but are not realistic enough to buy it, and ignorant people who are unaware of the need for it. But I think that what we have now may be the best we can do, provided we monitor the system to control, as much as possible, abuses due to greed and dishonesty.

Robert M. Miller, DVM, is an author and a cartoonist, speaker, and Veterinary Medicine Practitioner Advisory Board member from Thousand Oaks, Calif. His thoughts in "Mind Over Miller" are drawn from 32 years as a mixed-animal practitioner. Visit his Web site at www.robertmmiller.com.

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