Are not a good mix

Cancer treatments are dangerous.

They require specialist protocoles, highly qualified staff, an investment in technology and a well coordinated team of staff to manage the patients side effects.

Oncology is an expensive and resource intensive specialty.

In Australia, the majority of cancer treatment are now being conducted in private hospitals, many of which are small, have no after hours Doctors and only a skeleton of casual nurses.

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

And dealing with a recurrence of breast cancer is not the time to find that out…

A women in her forties called Megan was diagnosed with breast cancer.

She had surgery, then was given six months of chemotherapy in a small but expensive looking hospital.

There was no education before here first treatment, the specialist just handed her a card with an appointment time.

The was only one nurse administering chemotherapy to up to ten patients sitting in the tiny day unit.

No health assessments during chemotherapy were ever done.


Seven years later the cancer returned on the same breast.

Megan's oncologist told her that this time surgery was not an option. He told her that the cancer was wrapped around several nerves in her chest.

Megan was put straight back on to chemotherapy.

No second opinion was offered.

No clear plan was given.

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

Megan's private oncologist tried different drug regimes, swapping her drugs around.

Megane’s health deteriorated dramatically under the pressure of continuous chemotherapy treatments. She developed mouth ulcers, dental decay, had a continuous metallic taste in her mouth, lost a large amount of weight and burst into tears continuously.

Megan's private oncologist brushed her off with the comment that 'chemotherapy was just a hit and miss affair.

Megan was paying substantial health insurance fees as well as out of pocket costs for this treatment.

She had no way of knowing that if she had gone to a public hospital in the same city, for the same treatment, her management would have been entirely different.

The reason is, different hospitals have their own 'in house' protocoles for -

  • Patient education
  • Health assessments
  • Charting chemotherapy doses to ensure they are accurate and
  • Getting a second opinion when treatments fail

These hospital protocoles are not made public.

Neither is the education standards of Doctors and nurses across different oncology units.

Or how they chart chemotherapy, using generic paper drug charts or oncology specific software.

Horrified by the poor treatment of their friend and seeing her disintegrating health and emotional distress, Megan’s work colleges urged her to see another Doctor

Finally she agreed and against her private oncologist’s wishes, saw a surgeon at a different hospital.

He was astonished that she had waited so long to seek a second opinion.

He advised her that he was confident he could remove the tumor. Surgery went ahead and was successful.

When Megan’s oncologist found out that she had seen another Doctor outside of his private clinic, he was extremely angry.

He refused to cooperate with Megan’s new surgeon, discuss her case or even share her medical notes.

Megan was caught between two Doctors from separate hospitals, both of whom had very different ways of managing patient care.

Her friends began to question the professionalism of her private treatment and encouraged her to see another oncologist.

Megan took their advice and was surprised to experience completely different treatment.

Her side effects were taken seriously. Health assessments were comprehensive. All medical records including drug charts were electronic. And she was actively involved in her future treatment planning.

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

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

Megan died peacefully in a palliative care unit, several years later.

In some cases, (Care, Quality Commission) CQC found that a lack of formalised governance procedures meant that (private) hospitals were not effectively monitoring the work of consultants who operate under “practising privileges” – where a consultant clinician works in a hospital but is not a direct employee.

“For too long private sector treatment has remained unaccountable and opaque. This cannot be allowed to continue and the Government must ensure private hospitals operate with greater transparency.

Wikihospitals 2014

References

A third of private hospitals in England are providing substandard care - iNews April 2018

Medication errors in chemotherapy: incidence, types and involvement of patients in prevention. A review of the literature -  European Journal of Cancer Care, May 2010

The state of care in independent acute hospitals - Care Quality Commission 2018