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Small hospitals and chemotherapy protocols

Paying more for private healthcare does not necessarily mean you will get better treatment

Complex medical treatments like chemotherapy require a large health team, specialist trained staff, access to highly skilled Doctors and specialised oncology software.

In Australia the majority of cancer treatment is now being conducted in the private sector.

This can mean chemotherapy being given in small private hospitals that are using paper drug charts and have a skeleton staff of unqualified nurses.

Medical consultations in private rooms may have no access to other doctors to give a second opinion or expensive specialist software to ensure safe doses of chemotherapy are charted.

Most people think that ‘paying more’ means that you ‘get a better service’. But in healthcare that simply is not the case.

And the end of your life is not the best time to find that out…

A middle aged women called Megane was diagnosed with breast cancer. She had surgery, then was given six months of chemotherapy in a small hospital.

Seven years later the cancer returned on the same breast.

Megane’s oncologist told her that surgery was not an option. The cancer was wrapped around several nerves.

“The tumor is impossible to remove surgically” her private oncologist told her.

She was put straight back on to chemotherapy.

No second opinion was called for.

Chemotherapy treatment continued unabated, for nine months. At first the tumour shrank, then it grew back again.

The private oncologist tried different drug regimes. 

In the meantime Megane’s health deteriorated under the pressure of continuous chemotherapy treatments.

How can patients make good choices when there is no information available?

Megane lost a substantial amount of weight.

She was continuously unwell with a foul metallic taste in her mouth and grinding nausea.

Unable to see a positive outcome, she became very distressed and frequently burst into tears.

Despite the ongoing treatment with no successful outcome in sight, Megane was never referred to another doctor for a second opinion.

Her private oncologist just told her that “chemotherapy was a hit and miss affair”.

There were no health assessments of people undergoing chemotherapy at this small clinic or the small private hospital next door.

No patient was ever reweighed during chemotherapy.

Chemotherapy doses were written up on normal paper drug charts.

No information about dietary intake or bowel movements were documented.

No vital signs like blood pressure, temperature or pulse were ever done.

No one asked Megane about her emotional state or feelings about her current treatment.

It was just a quick set of bloods, a quick private consultation then chemotherapy delivered at the small private hospital.

The only nurses Megane saw were the enrolled nurses who worked at the clinic, made appointments and took payments, and the one chemo nurse at the private hospital, who gave the chemotherapy for up to 10 patients at a time.

Megane paid high health insurance fees plus continuous out of pocket costs for this private treatment.

She had no idea what sort of treatment she would have received if she had gone public for the same condition. 

Information about hospital protocoles, staffing levels and medical records systems are never made public.

No patient should be left to find out that their treatment has been substandard, at the end of their life

Megane’s health continued to deteriorate. She lost more weight, her teeth decayed and she was so exhausted that she was unable to continue work.

Horrified by the deteriation of their friend, Megane’s work colleges  urged her to seek a second opinion.

Finally she agreed and against her private oncologist’s wishes, saw a surgeon who was skilled in performing complex cases.

The surgeon was astonished that she had waited so long to get a second opinion.

He advised her that he was confident he could remove the tumor. Surgery took place and the cancer was removed.

When Megane’s private oncologist found out that she had seen another Doctor he was extremely angry.

He refused to cooperate with Megane’s new surgeon. He refused to discuss her case or share her oncology notes.

Megane became the unwilling victim, caught between the two specialist Doctors. She and didn’t know what to do.

Her friends began to question the professionalism of her private oncologist.

They looked up her type of chemotherapy on the internet, and found out it causing heart damage when given over an extended period of time.

Megane spoke to a nurse working in the public health system. She discovered that her entire treatment would have been very different, if she had gone to a public hospital for the same treatment.

It dawned on Megane, that despite all the money she had paid out over the years for her private treatment, she had actually received a very low quality of care.

Megane finds peace in the end

Megane’s friends found her a well established cancer centre and convinced her to leave her private oncologist.

This was still a private hospital, but it had a multi-disciplinary approach, the same computerised chemotherapy drug charts used in public hospitals and well qualified nurses.

Megane found a new oncologist who stopped her chemo, managed her symptoms and gave her support.

The cancer eventually spread to Megane’s bones. But she was very grateful to have found caring and qualified staff.

Megane died peacefully in a palliative care unit, a year later.

Wikihospitals 2014

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