The patient, lean and in his 60s, was in the hospital for the second time in a month with blood sugar levels that were out of control and he was not happy. Despite the nurses’ earnest attempts to cheer him up, he scowled and insisted that all he needed was for us to “fix it” so he could go back home.

“We have to keep looking because you may have other serious problems that caused your blood sugar to go up,” I said, preparing to rattle off a list of potential causes.

“You bet I have other problems, Doc,” he growled back. I watched the color in his face rise as he described the death of one of his adult children in a car accident several years earlier. His mouth quivered as he spoke of another child who had became seriously disabled while fighting in the military. And his eyes teared up as he described losing his job as a custodian at a local office building.

“I can’t pay for my medications, I can’t do enough for my son, and I miss my baby,” he said, now weeping.

At that moment, I knew that I could diagnose as much as I wanted, prescribe, operate, and enlist the help of an army of primary care and specialty colleagues; but he would be back. Whatever the reason for his elevated blood sugar levels this time, sooner or later his grief would envelop him, he would be overwhelmed with his caretaking duties or he would run out of money for his medications, and he would be back at the hospital once more.

What I could take care of was only the tip of his healthcare concerns.

I remembered this patient, and many more like him that I have encountered in practice, while reading a new book, “The American Health Care Paradox.”

Studies since the 1980s have shown that despite spending enormous sums on healthcare, Americans are less healthy than their counterparts in other developed countries. In the most recent studies comparing the United States to 17 other wealthy industrialized nations including France, Japan, Canada and Britain, Americans had a shorter life expectancy, higher rates of disease, the highest rates of infant mortality and the lowest chance over all of surviving to middle age.

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