On Reading Harrison’s Principles of Internal Medicine for the Last time

Chapter 5

Healthcare Systems in Developed Countries

Not too sure what this chapter has to do with becoming a master clinician. All I got from this was that healthcare is expensive and it seems all delivery systems are pretty screwed up in their own way. The bottom line is if you have the means, you can get better care no matter what the system. The leaders in socialist countries do not wait in line nor do the wealthy in other countries. It’s not equitable but it is what it is and begs for change at least in pediatric and pre-natal care.

In 2021 my 6-year-old grandchild contracted Covid and recovered without incident or so it seemed. A few months later he started having issues with urinary frequency. My concern was type 1 diabetes. His parents took him to the pediatrician, he saw the nurse who did a urinalysis and said it was negative. I was relieved. His symptoms continued for two more days and once again my grandson saw the nurse who checked his urine and said it was negative for glucose. When your worst fears are allayed, you go with what you want to believe even when you know better.

The symptoms continued and the next day we went to the drug store and got keto-sticks as they didn’t carry urinary test strips. He was positive for ketones!! There was no way those two previous urinalyses were negative.

We went to our friend’s house that had a son with diabetes. She poked my grandson’s finger and the child’s glucose was over four hundred with ketonuria. He was in life threatening DKA.

We went to the emergency room where he was found to have a dangerously elevated blood glucose of over seven hundred. He remained in intensive care for several days and was discharged diabetic, but in good condition. He accepted the diagnosis and went on with his life as a normal, beautiful, six-year-old, smart, energetic boy. He saw a local endocrinologist that instructed his parents to poke his fingers and check his blood then give their child an insulin shot. They were to do this a minimum of four times a day. That would be eight terrifying needle sticks daily.

At the age of six we were told he was too young to have a continuous glucose monitor (CGM) that would painlessly record his blood sugar.

It was heartbreaking to watch my son prick my grandson’s delicate, small, finger and produce a drop of blood, place it on a test strip, enter it into a sensor, determine his glucose level, then inject insulin. Childhood should be “snakes and snails and puppy dog tails,” not finger sticks and shots.

We took him to the Massachusetts General Hospital where we met with a dedicated competent pediatric endocrinologist and a nurse practitioner. They advised the use of a continuous glucose monitor and an insulin pump that would continuously inject insulin through a plastic tube. The tube is inserted under the skin with a very small mosquito bite size probe. No shots. Now with his sensor and insulin pump, my grandson is doing very well which makes grandpa very happy. My grandson exhibits the faith, resiliency, and trust of a child. He is an inspiration to me and evidence of the heroic nature of children confronting a chronic disease. They accept and move on.

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There is a social issue here which defines the difference between equality and equity. Equality means anybody can get type 1 diabetes. Equity is how the youngsters are treated. An insulin pump costs six to ten-thousand dollars. Yearly supplies cost twelve thousand dollars per year. Those with adequate health insurance or the means to pay out of pocket can obtain the most sophisticated insulin pumps and sensors. In countries where the governments finance the cost, socioeconomic status does not influence the outcome. Sadly, in the United States socioeconomic status is critical to the health of diabetic children.

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