28 Review

By Dr Victor Van Hee

Michael Moore's SiCKO – Another Heroic Failure?

espite his ability to make some of the most coverage, we have to wonder if this will be yet accessible and stirring documentaries another heroic failure. D that demand viewers to take political In SiCKO, we meet Americans who could easily action, Michael Moore's movies have yet to move be our patients – and every American doctor can Americans to change. Years after we learned about tell at least one story about a patient failing to the individual human pain and suffering caused get needed treatment because of lack of sufficient by corporations in Roger and Me and The Big One, insurance. We meet a middle-aged, insured couple corporate America continues to receive broad forced to sell their home and move in with their support from Americans, even as it exploits workers children because of an endless barrage of copays and continues to value profits over people. Bowling and deductibles. He has had three myocardial for Columbine's frightening glimpse into America's infarctions, she has cancer. The bills have left them culture of gun ownership and violence did not do with nothing. We meet an 82-year-old man forced anything to prevent just about any American from to continue working a low wage job at a supermarket easily purchasing an assault rifle. Despite the to pay for medications. We meet a long list of scathing commentary on the Bush administration Americans denied coverage by HMOs for potentially of Fahrenheit 9/11, George W Bush was re-elected life-saving treatments. We meet Americans who have for a second term, and the Iraq war continues died after being denied coverage. Michael Moore today. Michael Moore regularly presents a need introduces us to a group of 9/11 rescue workers for change in such a way that no reasonable person who cannot get adequate healthcare for conditions could disagree with his conclusions, and each time related to their service after the disaster. All of these Americans fail to enact change. individuals are the heroes of SiCKO, and Michael But none of these failures have stopped Moore takes them on a literal and symbolic quest Michael Moore from making yet another excellent to overcome the healthcare policies of America in a documentary that provides compelling arguments boat ride to Cuba. for political change. This time, he has set his We meet non-American heroes, too, in the sights on another easy, but very deserving, target – doctors of France (who even make house calls!) Dr Victor Van Hee is America's healthcare system. He again demonstrates and Britain and Cuba, a passionate and articulate an Acting Instructor in Occupational his ability to make politics interesting, even British socialist, and even a government-employed and Environmental entertaining, to the average American by letting French maid who does laundry and cooks food for Medicine at the University of us meet the villains and the heroes that make, or mothers who recently gave birth. As in all Michael Washington. He are maimed by, those policies. This time, he even Moore's films, SiCKO is strongest when it takes us has contributed goes so far as to implicitly call for a revolution deep into the lives of individuals and shows us their to several (now defunct) weblogs in (and we hear the Rolling Stones classic “Street overwhelming pain and their small joys. the past, including Fighting Man”). Despite these well-told stories of SiCKO's main weakness lies in its lack of human “The Lingual Americans dying because of the health insurance villains with faces – its villains are primarily Nerve” and his own “Hermes: A system and happy Europeans and Cubans living faceless HMOs, intangible. We do get another Resident’s Life”. long and healthy lives because of their universal classic, unbelievable quote from Michael Moore's

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Page 28 – Michael Moore’s SiCKO – Another Heroic Failure? or the multitude of reasons for rising healthcare favourite villain, George W Bush (something costs in America. It focuses little on the uninsured. about obstetric gynaecologists not being able It is difficult to fault Michael Moore for simplifying to “practise their love with women”), a clip of something so complicated as American healthcare Ronald Reagan, and some stock video footage because there are many Americans and even of a medical director of an HMO, but we do not many American physicians, who have difficulty get a personal interview that takes us into the comprehending the system. Michael Moore chooses psyche of the villains of the American healthcare the difficult, sometimes tragic, situations that system. We do not get Bowling for Columbine’s make his point: Because America does not have interviews with McDonnell Douglass executives universal healthcare, these tragedies could happen or Charlton Heston, or Roger and Me and The Big to anyone. One’s meetings with CEOs and Senators. Perhaps SiCKO is not surprising, and its villains are Michael Moore has become too popular for his not as compelling as in Michael Moore's prior own good – the villains are wary. works, but it is a story well told by an American SiCKO does not cover the entire American who deeply cares for the everyday Americans who healthcare system. It does not even attempt to are his heroes. We can only hope that it is not still explain the complexities of Medicare, PPOs, HMOs, another heroic failure. n

Page 27 – Making the Cut: A Surgeon’s Stories of Life on the Edge this with a hilarious example – a 40-year-old man whose “itchy arse” sets off a catastrophic domino Memorable patients include the young Muslim effect, climaxing in an event which is guaranteed to boy with terminal leukaemia, whose fate is eventually elicit any reader’s mirth. decided by his suffering mother; the sleazy Jack Despite being pegged as “A Surgeon’s Stories Ignatius whose interest in penile implants belies a of Life on the Edge”, Making the Cut will strike a much more sinister motive; and the 22-year-old Jo chord regardless of your specialty. It is no surprise Tavali, whose only validation of his true identity is obtained by contracting a kidney tumour. that Khadra’s praise is reserved mainly for the Khadra admits to his own mortality in two surgical discipline (though I vehemently disagree chapters, one detailing his admission for fast atrial with his statement that rejects from the surgical fibrillation, another his battle with thyroid cancer. training programme usually end up in emergency The latter experience proves pivotal in influencing medicine, ahem!). But we have all been there: the his decision to leave surgery, after his newly enhanced endless night calls, the fear of making a mistake “ability to relate to the genuine suffering among my and killing a patient, the doubts and regrets, the patients increased dramatically”, breaking down triumphs and celebrations. “the barriers between my own inner sanctum of However, it is to Khadra’s sole credit that his protection and the patient’s suffering”. story brims with humanity, yet never teeters over My main enjoyment, however, is derived from into outright cheesiness. He walks this fine line his anecdotes about other medical colleagues, both with grace and dignity, right until the closing medical and surgical, junior and senior. There are chapter where he bids farewell to his last batch of the mentors who groomed and inspired him, his medical students. peers who fell from grace and succumbed to drug “You are extraordinary human beings on the addiction and suicide, the nurses who either saved brink of the greatest of all careers that any could his skin or made his rotation a living hell. ever hope to have. You have, within your grasp, the In the penultimate chapter, “Malpractice”, ability to alleviate suffering, to take away pain, to Khadra describes his own brush with a lawsuit, cure disease and, most importantly, to know when listing disturbing statistics: how “30% of patients to let nature take its course. Above all, stay true to sue doctors because they allege the doctor failed yourselves. This is not a business. This is a calling, to inform them”, and “on average, patients retain and the day you stop thinking of it as a calling is the less than 10% of the advice they receive from their day you must leave. caregiver”. He relates how one such patient, a Miss … It is OK to be scared. But do not be paralysed by Spencer, gave her fully informed consent, only to it. When you are scared, hand the reigns to others… retract it post-op and slap him with completely There is nothing worse than the doctor who puts ego unfounded accusations. Obviously, many of us ahead of a patient’s welfare.” already know what that feels like. I am merely one of many who have been touched Last but not least, Khadra cautions that “Defensive and inspired by Prof Khadra. I sincerely hope a medicine is not safe medicine”, perfectly illustrating sequel is not far behind. n

SMA News November 2007 Vol 39 (11)