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US Doc Contrasts His Cancer Care - Article

nudgie's picture
nudgie
Posts: 1483
Joined: Sep 2006

U.S. doctor contrasts his cancer care with uninsured patient who died
By LINDSEY TANNER (AP Medical Writer)
From Associated Press
April 03, 2007 6:51 AM EDT
CHICAGO - Frustrated by the U.S. health care system, an Oklahoma doctor being treated for colon cancer decided to write an essay for a medical journal.

But it is not his own care that upset him. It is the plight of America's uninsured - specifically a patient of his who was the same age, had the same disease, yet could not afford the same treatment he got.

The United States is one of the few western nations not to have universal health care. Many adults are insured through their jobs, and there are also government benefits for the poor and elderly or disabled. But there remains a huge number of adults who are uninsured.

Today, Dr. Perry Klaassen, 67, is still working part-time in an Oklahoma City clinic, six years after his diagnosis. Shirley Searcy, his patient, died 18 months after hers.

Klaassen's treatment included surgery two days after diagnosis and costly new drugs that have kept him going despite cancer that has now spread to his lungs, liver and pelvis.

"I received the most efficient care possible. I was 61 years old and had good group health insurance through my workplace," he wrote in the essay.

The doctor did not name Shirley Searcy in his March 14 article. After all he had been through, he could not remember her name. But for days he dug through old medical files searching for her identity after he was interviewed by The Associated Press. He realized he could shine a more powerful light on the plight of the uninsured if her story could be told more fully.

And it is a story that is far from unique. The widowed mother of eight grown children, Searcy had little money. When she began to sense she might be sick, she put off going to the doctor for a year because she knew she could not pay the medical bills. Deeply religious, she put her faith in God, according to her family.

By the time she saw Klaassen, her cancer had spread from her colon to her liver. She had surgery but rejected chemotherapy.

"She just really didn't feel like she wanted to endure what that would cost physically or financially," said her daughter-in-law, Karen Searcy.

Shirley Searcy died Dec. 22, 2003, about 18 months after her diagnosis.

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While recent attention has focused on high-profile cancer patients like Elizabeth Edwards, the wife of presidential candidate John Edwards, and presidential spokesman Tony Snow, people who have the means and insurance to pay for the best treatment, there are tens of thousands of tragic, unseen cancer cases like Searcy's - people whose lack of insurance stops them from seeking care when they should.

An estimated 112,000 Americans with cancer have no health insurance, according to Physicians for a National Health Program.

And that is only cancer. Among the 45 million Americans who have no health insurance, there are countless people with chronic and developing health problems who are risking the same kind of fate that took Shirley Searcy's life.

Klaassen's essay in the Journal of the American Medical Association illustrates the issue "right there up close and personal," said editor Dr. Catherine DeAngelis.

It underscores that insurance can be a life or death issue, said Paul Ginsburg, president of the Center for Studying Health System Change, a nonpartisan policy research organization. "The cost of health insurance has been going up faster than people's incomes," he said.

U.S. spending on health care totaled $2 trillion (euro1.5 trillion) last year and economists in February projected it will nearly double by 2016.

Said DeAngelis: "We have the richest country in the world and I think the poorest health delivery system in the developed world. It's really sad."

Klaassen no longer sees patients but works part-time as medical director of an Oklahoma City group that recruits doctors to give free care to needy patients.

Always healthy and vigorous, his diagnosis in 2001 came as a shock.

He went to his family physician after experiencing an annoying pain in his lower abdomen for a few weeks. A CT scan showed possible inflammation, but his doctor recommended a colonoscopy, the gold-standard test for detecting colon cancer.

Klaassen had the test within two weeks. When the specialist ready with the results asked, "Is your wife with you?" Klaassen wrote, "I knew immediately that I had colon cancer."

His wife was out of town, and needing someone to share the awful news with, he turned to a physician friend "and I broke down and cried."

Surgery two days later showed the disease had spread outside the colon wall and to nearby lymph nodes. It was not quite as advanced as Mrs. Searcy's, whose disease had spread to the liver.

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Shirley Searcy married young and had her first child in her teens. Her mechanic husband died in a 1978 car crash, leaving her to raise the family alone. Government financial benefits helped, but the Searcys never had anything extra, family members said.

"Life dealt her more I guess than some people have been dealt," her daughter-in-law said.

She did not work outside the home, did not venture often beyond her four acres and the frame ranch house where she raised her children in the humble town of Blanchard, about 30 miles (48 kilometers) from Oklahoma City. In her later years, reading stories to her dozens of grandchildren was a favorite pastime, family members said.

She believed she would live long enough to qualify for government health benefits for the elderly at age 65, they said, but she missed it, by just a year.

She had had symptoms for at least a year before going to the doctor, her family said.

"She put off going because of no health insurance and she wanted to trust the Lord. She was hoping to be healed," said her daughter, Melba Spalding.

A relative referred her to Klaassen, a primary care doctor in the city, because she had had abdominal pain, lost weight, and had bloody stools. She had been hospitalized several months before and urged to get a colonoscopy, but still had not had one when she went to see Klaassen.

With his own diagnosis fresh in his mind, Klaassen knew immediately that it was colon cancer. A colonoscopy weeks later confirmed the diagnosis and the family learned the disease was incurable.

The diagnosis was "heartbreaking to all of us," said Spalding, 50, the oldest of Mrs. Searcy's children. The family had always been close, and Mrs. Searcy "was pretty well the hub of it," she said.

With her colon diseased, Mrs. Searcy had a colostomy, surgery that creates an opening in the abdomen for waste removal, and worried about how to pay for all her medical supplies, Karen Searcy said. She did not want to burden her family, but Karen said she and her husband, Kenneth, lived nearby and helped out.

Still, their own finances have sometimes been a struggle.

Karen said they had no health insurance when the first two of their four children were born. They needed help to pay for the births.

Now they are covered through Kenneth's job as a plywood salesman - a godsend since he has diabetes, high blood pressure and high cholesterol and subsidized co-payments alone for his medicine have totaled $90 (euro67) a month.

"There's a lot of mixed emotions about health care in my mind," Kenneth Searcy said. "You really can't afford it, but you can't afford not to have it."

With insurance, Mrs. Searcy would have sought treatment sooner, family members said.

"I believe with all my heart that if she had gone to a doctor early on, that she would still be living," Karen Searcy said.

She said her mother-in-law held up pretty well after her surgery in January 2003. But by that Thanksgiving, when she could no longer make her holiday pies, the gravity of her situation finally hit her.

"She broke down and cried and she realized that her strength was gone," her daughter-in-law said.

Shirley Searcy died a month later.

---

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JAMA: http://jama.ama-assn.org

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vinny3's picture
vinny3
Posts: 933
Joined: Jun 2006

A very distressing story but one I am very familiar with after the years I spent in Family Practice. The problem is how to get enough pressure on the politicians to make a change for universal health coverage. One can see from the Medicare Drug bill that they are not likely to do much that is going to take the profit away from the big corporations. Their main concern seems to be how to raise enough campaign money. Thus they bow down to the big corporation lobbys and groups including the American Medical Association. Something needs to be done to get a large enough group to apply the pressure. We need an organizer.

Thanks for the info.
Dick

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vinny3's picture
vinny3
Posts: 933
Joined: Jun 2006

You are right when the government mandates it but does it through the insurance companies (so they make a profit off of it) or other intermediaries and the people still have to pay for it despite their income level except for the lowest income levels. The only way it would work would be total control of the whole system. That is going to face alot of opposition and the argument that it will create long waiting times for care and poorer care. I'm not that familiar with some of the European systems but it seems like a public base of care with the ability to have extra insurance privately might work out. It might mean a two-tiered system but at least care would be provided for everyone as a baseline and people would not go into massive debt to obtain the proper care.

Dick

mwomack
Posts: 78
Joined: Jan 2005

I may be missing something, but I really don't see how the Dr. can compare his cancer and treatment to hers. She chose not to do the chemo.

I did not read throughly but it sounds like she got the standard of care once she chose to seek treatment. Who paid for the colonscopy, surgery, etc. There is no mention that she paid the bills. I thought Medicaid was for this situation.

There have been plenty of "chemo buddies" that do not have insurance that have gotten basically the same care as my husband. Maybe the state has a lot to do with it??? Where does Medicaid come in?

MA

2bhealed's picture
2bhealed
Posts: 2085
Joined: Dec 2001

Personally I hope we do not get Universal Health Care ever! The present "health care" system is really "disease management" and does little to address PREVENTION as being key.....look at the son-in-law with diabetes, high blood pressure and cholesterol. Three diet related diseases and I would venture to guess he's on expensive drugs rather than dietary reform as is often the case.

I am on payment plans with 6 different doctors and clinics presently so I never understand when people hesitate to get serious medical attention. My first son was born by c-section with no insurance and the hospital and doctors did not turn me away eventhough it took me over three years to pay for him but we did it penny by penny. My last child was born with medical assistance and we had insurance but still qualified. there ARE programs in place. If you talk to the hospitals and clinics personally there are programs in place that will help you pay your bills. You just have to ask.

Let's look at the exorbitant prices the drug companies charge for their pills and powders......that's where the crime is.

Had she gone when she first had problems.......had some doctor told me to get scoped when my sister died......dang this disease!! But we have to take some responsiblity for our actions and not always look to Big Daddy Gov't to bail us out and pass the expense on to us. No thank you.

peace, emily who is thankful to live in the US and have the health care options we have

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