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Advertise on the Tentacle

May 29, 2008

A Medical Prescription

Patricia A. Kelly

Our medical system is broken. It’s up to you to navigate it, advocate for yourself, and get good care in spite of it. You are your own best bet.


Insurance companies pay for high tech treatments, the bulk of the health care dollar going to expensive care in the last months of life.  They don’t pay much for low technical care.


Attorneys, and our “It’s All Your Fault” society members, circle overhead, waiting to pounce with lawsuits against health care practitioners.


Physicians fail to police themselves, allowing poor doctors to remain uncensored in practice, increasing distrust and lawsuits. Even the best are covering themselves with expensive tests, reluctant to speak the simple truth to patients, or to trust their own clinical judgment.


You can go to any emergency room with belly pain and get a C.A.T. scan. Even if the doctor, who may be a great one, is sure it‘s nothing serious, he‘ll usually order one. Insurance will pay for it, for one thing. For another, if you come down with appendicitis – or some other serious, treatable condition – in the next few days or weeks, you‘ll probably sue him.


The doctor just can‘t get away with telling you that screening lab tests and x-rays are negative, that illnesses evolve, and that you should return for worsening symptoms.


The problem with this is that C.A.T. scans costs a lot of money, and exposes your body to radiation equivalent to 100 chest x-rays. How often do you want to go there?


I have visions of thousands of patients, over the next 30 years, suing for radiation damage from C.A.T. scans, just as they might now sue for lack of them. I know a doctor who says he’d have his child undergo surgery for suspected appendicitis rather than be exposed to the radiation in a C.A.T. scan.


People are in the Emergency Department in the first place because:

                        A. their doctor’s office is closed;

                        B. their doctor doesn’t know them from Adam because their insurance just changed and sent them to him, so he’s covering himself;

                        C. they have no clue as to what symptoms are generally associated with minor illness, and what are more likely serious, and no one has the time to educate them;

                        D. they’re off work today, so it seems a good time to check things out;

                        E. they’re Americans, so expect someone to fix things right now; and

                        F. they can’t be turned away for lack of ability to pay.


Emergency Departments are becoming the dumping zone for all sorts of not-really-emergency things. This will get worse before it gets better. Insurance costs are up, partly because of those C.A.T. scans, and because the personal, trusting relationship between doctor and patient is gone, partly because insurance changes cause doctor changes.


The emergency staff doesn’t know you either, so do lots of tests, rather that trust you to follow up.


In Frederick, the most popular referrals for the working poor outside of the Emergency Department are Mission of Mercy, a private charity.


Drugs in America are risky business. The Food and Drug Administration barely keeps up with new drugs, and is very much driven by pharmaceutical company pressure to quickly approve them. Many savvy people wait awhile before taking anything new, waiting for reports of injuries or recalls, as so often happen.


And, by the way, if Tylenol Arthritis controls your arthritis pain, you probably don’t need a new drug, even if insurance will pay for it.


The best answer for now is to advocate for yourself. Go to your primary physician organized and armed with information, and your written questions. He doesn‘t have much time to talk, but you can enlist him or her as your health care partner.


Tell him your medical history, briefly. List any other doctors you are seeing and for what. Tell him what you’re doing at home to keep yourself healthy. Take along a complete list of all drugs and supplements you are taking, both prescribed and over the counter. Ask your doctor to review it and place it in your chart. Keep it in your wallet, too, along with a list of your allergies, your doctors and your next of kin. Learn to Keep It Up To Date.


Work hard to learn about your own health and to be clear and direct. Be brave, and encourage your doctor to be clear, too. You have a right to know the benefits and risks of any proposed treatments. You have a right to know the definition of “will benefit from.” He has a right to get on with his rounds.


If you have a medical condition such as high blood sugar, and you don’t do the work to keep your sugar down, don’t expect a miracle from the medical system. If your dad is 94 and has smoked two packs a day for 70 years, don’t expect time on a ventilator in ICU to cure his lungs.


Your doctor is not very happy with the way things are going either. Help him out. Be responsible and reasonable. Take charge of organizing your own care. It is, after all, your life.


Yellow Cab
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