‘Our Malady’ by Timothy Snyder: Lessons for Australia in health care

While this is a book about American healthcare, it raises issues that are relevant to Australia. Written earlier this year, many issues facing current healthcare – both in hospitals and in the community – are discussed. 

Because I have enjoyed his other books, I recently purchased a copy of Timothy Snyder’s latest book entitled ‘Our Malady. Lessons in Liberty from a Hospital Diary’. Snyder is Professor of History at Yale University, an expert on eastern European history and a gifted writer. He speaks and writes in English, French, German, Polish and Ukrainian. Brought up a Quaker, he became a close friend of Jewish historian, Tony Judt. Judt was born in London of Jewish refugee parents and became Professor of European Studies at New York University in 1987. Judt is particularly known for his landmark book ‘Postwar: A history of Europe since 1945’ published in 2005.

In 2008 Judt was tragically diagnosed with amyotrophic lateral sclerosis (called motor neurone disease in Australia). He became paralysed from the neck down and steadily deteriorated, dying in 2010. Snyder visited him frequently over the last year of Judt’s life and had long conversations with him. This resulted in the book ‘Thinking the Twentieth Century’ published in 2012 based on their conversations.  Recorded and edited by Snyder, it presents Judt’s view on the history of the 20th century in a very thoughtful manner.

Snyder’s latest book is different to anything he has previously written as it is based on a diary he kept throughout his recent experiences of appalling care in three American hospitals. He was admitted to hospital in Connecticut USA on December 15, 2019, with abdominal pain and had an appendicectomy. He was discharged less than 24 hours later. On holiday in Florida, he was re-admitted to hospital there on December 23, but was discharged after only 24 hours. He gradually became sicker and sicker and on return to New Haven, Connecticut on December 29 was taken quickly by his wife to hospital. Here he spent the first 17 hours in the Emergency Room, seemingly ignored. It was eventually realised that he was desperately ill with septicaemia secondary to a liver abscess, itself a complication of appendicitis. His recovery took many months.

Snyder uses his terrifying experience to reflect on what he calls the ‘malady’ facing American healthcare. He points out that despite the highest GDP expenditure in the world on health care, life expectancy is lower in the USA than many other comparable countries. He highlights the current issues of crowded emergency departments and criticises the medical staff who seem to be servants of corporate medicine, lacking the capacity to see and treat the whole person. He also points out that no democracy has mishandled the coronavirus pandemic as badly as America has done.

This is a short read, only 146 pages with another 30 pages of impressively detailed notes and references, but in this space he covers numerous issues. These include the opioid misuse epidemic; the appalling response to the Covid pandemic; recent budget cuts to public health; the dominance of private equity firms and insurance companies; the business model of social media; the downgrading of regional newspapers and local reporters; the centralization of commercial medicine; the difficulty for a hospitalised patient knowing who is ‘the doctor in charge’; the lack of regulation of surgical implants; scarcity of community doctors and nurses; the fact that specialists make more money than generalists; the fact that half of Americans avoid medical treatment (and I presume dental as well) because they cannot afford to pay for it; and the fact that even though he had adequate health insurance, he still had to pay thousands of dollars in unexpected fees.

His scope is wide ranging as he also addresses post-natal parental leave, the importance of universal early childcare and the social effects of the Covid -19 pandemic. He even introduced me to the term ‘nomophobia’ – the spreading of addiction to mobile phones – and its current effects.

Snyder’s insights are enhanced because he has had lived experience of universal health care in more than one western European country  and he uses this experience to seek to explain to his fellow US citizens that there is a better way.

While this is a book about American healthcare, there are issues raised that are relevant to Australia, if only to alert us to things we must strive to avoid. I highly recommend this book to all interested in improving healthcare. As an additional benefit, the book might also serve to introduce readers to the other writings of Timothy Snyder and the work of Tony Judt.

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Dr Kerry Goulston AO is a retired physician and gastroenterologist. Past positions have included Associate Dean, Northern Clinical School of the University of Sydney, Royal North Shore Hospital and Inaugural Chair of the Postgraduate Medical Council of Australia and New Zealand.

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