Does Dignity Matter?

I wrote an article for the Vienna Review some time ago lauding the health care system of Austria: My life was saved by professional emergency treatment for a life threatening attack of ventricular fibrillation. The crisis itself was almost exactly four years ago, in August of 2005. In light of the overwrought health care debate now raging in the United States it is worth looking at how my treatment has progressed since.

Is the Austrian system of almost universally mandated health care really superior to the poorly regulated and unevenly distributed American system?

I have had an unusual chance to compare systems: Over four years, I have received treatment in Austria for heart failure that ensued after the ventricular fibrillation was corrected; at the same time my sister was treated in Oregon for a similar condition.

What has become clear is that the issue of providing good health care is a complex one. The Austrian system has serious failings that could be corrected by adapting some the more important assets of the American system. The Americans need to make sure that its people have (near) universal access to health care that does not depend on how much they earn or whether they suffer from so-called preexisting conditions.

Because I have (rather expensive) supplementary health insurance and engage – and pay for, in spite of the supplementary coverage – the private services of a cardiac specialist in Austria, I should expect exemplary care.

Nevertheless the treatment, particularly the personal attention and consultations I have received, is distinctly inferior to the treatment my sister has received in Oregon. Long discussions with my sister, who eventually required a heart transplant, have revealed just how great the differences are.

As soon as my sister was diagnosed with heart failure after an extensive series of tests, she was assigned to a team of heart failure specialists to whom she had 24-hour access. The first step in initiating treatment was a detailed consultation with this team during which her condition was explained to her and her husband, and treatment options considered, including the possibility of a transplant. As treatment progressed, every aspect of the procedures and prescribed medication was explained in private sessions with her team of specialists.

As the need for a transplant became clear, she was transferred to the heart transplant team operating under the same principles.

I have never had such consultations. Over the years I have received a battery of tests and procedures, undoubtedly using state-of-the-art medical equipment, conducted by well-trained medical experts. And a number of medications have been prescribed.

Personal contact with those treating me, however, has consisted of long waits in overcrowded, faceless waiting rooms after which I report to a doctor who, after silently paging through my medical record hands me drug prescriptions and tells me where and when the next medical procedure will take place. The doctor then shakes my hand and wishes me well. Der Nächste bitte! (Next please)

My natural instinct, of course, has been to ask questions about my treatment and medications. The doctors usually give very short answers that betray irritation and, on occasion, even disdain. Why don’t I trust their expertise?

In one particularly telling incident a cardiologist retorted sarcastically: "Now I suppose you’re going to run to your sister and check the Internet!"

One of the most unpleasant side effects of the medication I have been prescribed is persistent vertigo and accompanying double vision. In spite of my continuing complaints, doctors in essence suggest that I am grossly exaggerating the extent of the problem. I must continue with the prescribed medication.

In an e-mail, an assistant physician at Vienna’s Wilhelminenspital told me that this was not a concern of the cardiology unit of the hospital at all, and that I should consult my local GP. Or if imminently threatening, to summon an ambulance. To which my cardiologist’s receptionist added: "better too often than too seldom."

I remember well when my sister asked rhetorically. "What? You’re not being treated by a team?"

I might add that my other sister and my 88-year-old mother, both living in northern Minnesota have received exemplary, compassionate care and rehabilitation services for extremely serious and complicated medical conditions at local facilities in Duluth, Minnesota. At a cost to them less than what I pay in Austria.

Perhaps then, there is truth in the conclusion of the World Health Organization that even though the United States may rank 37th in the world on the basis of the WHO criteria for health care, it ranks the United States number one in the world in responsiveness to patients’ needs in choice of provider, dignity, autonomy, timely care, and confidentiality.

Austria provides timely care and choice of provider, but is sorely lacking in respect for patients’ dignity – and intelligence.

The much maligned American system of health care does, in fact, have an egregious failing: Much of it is available only to those who are fortunate or privileged enough to have comprehensive health insurance.

Correcting this indefensible flaw in the system is the main thrust of the health care (insurance) reform initiative of the Obama administration. The American system is also way too expensive and could in time bankrupt the nation.

However, if my experience is any indication, it seems that if President Obama’s initiative should succeed – which, as the world knows, is far from certain – the United States could end up with a health care system that is the envy of the world.