The continued raging against family med

Changed clinics, so I am no longer at the poor continued care clinic that lost its grant funding to pay for uninsured patients. Now I'm at an acute care clinic, which makes it oddly like weird mutt of the family medicine and emergency medicine breed. We only care about acute complaints, but we don't mind seeing you again in a couple of days.

Yeah. I am frustrated and sad and disappointed in what family med can do for patients. And it's at this clinic too. So what does that even tell me? Is it just these two clinics? Gosh. Just gosh.

A Malaysian lady comes in for generalized pain all over her body and tells us it's been going on for almost a year, unexplained weight loss of 10 kgs, general malaise, etc. (I mean, hey kinda suspicious for cancer, or I'm thinking maybe a little fibromyalgia or something even though that's by exclusion). Not good stuff, y'know? But she says she got all her labs done in Malaysia, etc etc. I go back and tell my attending. Doc and I walk in and he just has to clasp his hands together and tell her that we need to repeat all the labs and imaging because she's not in the US system. But, she stares at him a little blankly, I had all the labs done.
But not here, he tells her.
I am just standing. A medical student. A bystander. It's like watching a car crash.
They go back and forth saying the same things.
I know the results.
But I can't do anything without the standardization here. To another doctor's eyes, it would look like we haven't even checked all the basic labs.
But I've done all of the basic labs.
I know. But not in the US.

I don't know what to say. How much more silently can I stand? What could I say?

My gyn checked by blood and hematocrit and he always does an ultrasound of the kidney.
Did you bring the results?
No... but they came back normal. And he always does it. I had them done in June.
Your gyn is in Malaysia, right?
Yes...
Ma'am, every country's lab standards are a little different. We would still have to repeat them even if they were normal there.

It seems like no one will give. But then she says:
How much would it cost?
He hesitates but says, for a CBC, a thyroid test, you would definitely need a colonoscopy, and a mammogram for the lump on your breast, we would want a CT.... $5,000?
She gasps.
She turns and looks at me incredulously.
I am sure I look like a stupid medical student just standing as if I could become a potted plant.
Each of those were $50 in Malaysia!
I know, ma'am. But we would need to go off data in the US.
She is silent for a long time, just twisting her fingers together and apart.

They exchange a couple more words, and he leaves her with a hope of getting a free mammogram some way through some charity and a written order for a colonoscopy that she might have to go back to Malaysia for. And I follow him out the door.

The strength in her smile that she gives me as I walk out is heartbreaking.

....
Now you see... I don't think I wrote the doctor justice. His tone as he spoke was not callous. Nor was it frustrated or mean or spiteful or anything of that sort. It was just "my hands are tied and what can I do, here is the information i have" sort of tone. And I feel for him. What could he have done? No doctor that wants to defend/justify their treatment plan would treat without some sort of labs or imaging. What could he have done?

But I am just so tired of feeling such sadness for the patient. What could she have done?

These questions hurt so much.

The doctor who says helplessly: What can I do?

and the patient who says in pain: What should I do then?

WHY IS IT LIKE THIS? Tell me, why is it like this?