On Sunday July 5, 2020 my father had a hemorrhagic stroke that greatly paralyzed his right side and speech. He is a 78-year old who eats healthy, exercises regularly, had gone regularly for medical check ups. His single biggest risk factor was slightly elevated blood pressure which was very much under control for years through low-dosage medication. So you can imagine the shock to him and everyone around.
The shock was further exacerbated by geography. My parents were born / raised in India where most of the family is, I was born / raised in Brazil as an only child. They are retired professors living in Brasília, I am a venture capitalist living in Silicon Valley. The three countries that we are most deeply connected to are usually a day’s travel away from each other. In the age of covid that is far more complicated — at the time and still as of now US, Brazil and India are the three countries most affected with extremely limited flights and entry — and I was fortunate to be able to get from SFO to BSB in 32 hours.
This is not an article about a medical emergency — a deeply personal journey that is its own story. What this article is about sharing lessons from experiencing another healthcare system. Brazil is a middle-income country with roughly 1/8 of the GDP per capita of the US. It’s arguably the most similar comp to the US, partly by design, with a public system responsible for about half of all healthcare expenditure and a private system featuring HMOs, PPOs, copays, deductibles and the like. What is different are the fundamental choices that one society has made, and this post focuses on three of them and the questions they raise.
1) Sharing — No thousand forms, no CDs, no faxes. All medical results (imaging, tests, doctor notes) were uploaded immediately on an online portal. The medical team didn’t frown on us sharing the username and password with many well-wishers. They in fact encouraged us to share with other healthcare professionals who could explain to us what was happening and also provide a second opinion quickly.
2) Openness — One of the well-wishers was my own wife who is a radiologist at UCSF. When the local team learned about this skillset they reached out to her themselves and started a dialogue. To our eyes it wasn’t a matter of doubt — the local doctors were as highly trained as any world-class doctors I have yet — it came from a place of openness.
3) Technology — Beyond the traditional methods of calling and in-person, the doctors and nurses communicated with us using WhatsApp. During business hours questions would get answered within an hour. After business hours if we needed something we could still follow up, for instance we communicated for a referral late evening and it was ready shortly thereafter. All of my father’s care became a Google Doc kept up to date. These are technologies in use in enterprise for over a decade that are still anathema in US healthcare. Well-wishers could easily follow progress, pos-discharge professionals (physical therapist, speech therapist, caretaker) could quickly understand and then add to the medical history, the lead medical team could check in without a lengthy appointment.
Watching others’ choices leads to self reflection. HIPAA protects patients but also hampers communication, why should we have to make that trade-off? Same for medical malpractice, as in how can we avoid creating a culture of fear among healthcare professionals that stifles collaboration? If people rampantly use technologies like text messaging already, is it not time for us to update these laws? Do we really need to spend 34% of healthcare costs on administration, burdening doctors and nurses with paperwork?
The US spends more on healthcare than any other in absolute terms but also in relative terms among major countries. Case in point, 18% of our GDP goes to healthcare while OECD average (i.e., other developed countries) is 10%.
And yes there are vast differences within the US, counter-arguments and exceptions to everything. But one cannot help wonder if this American exceptionalism is really more a misallocation of resources, misaligned incentives, and misinformed choices rather than of economic limitations, which is the burden of poorer countries.
Can we do better? My father was discharged from the hospital after a serious hemorrhagic stroke in a week and is recovering very quickly. I cannot help feeling some of it is because of the choices allowing medicine to be exercised more freely in achieving its true goal — serve, protect, cure.
Thanks to Preeti Sukerkar and Mihir Gupta for their thoughts. Originally published on “Data Driven Investor,” am happy to syndicate on other platforms. I am the Managing Partner and Cofounder of Tau Ventures with 20 years in Silicon Valley across corporates, own startup, and VC funds. These are purposely short articles focused on practical insights (I call it gl;dr — good length; did read). Many of my writings are at https://www.linkedin.com/in/amgarg/detail/recent-activity/posts and I would be stoked if they get people interested enough in a topic to explore in further depth. If this article had useful insights for you comment away and/or give a like on the article and on the Tau Ventures’ LinkedIn page, with due thanks for supporting our work. All opinions expressed here are my own.