Wednesday, May 13, 2009

Modern Health Care

I broke my foot the other day in a silly accident.  Nothing exotic.  Nothing that I really will have great stories about.  It was a common household accident that could and probably does happen to a couple of thousand people everyday.  I stepped on my foot the wrong way and just went down.  After a couple of minutes on the floor to assess the damage, I got up and walked carefully a few feet to sit down.  After twenty minutes, it was clear that this was more than a simple sprain.  It was time to go see somebody who knew what they were doing.


I went to an urgent care clinic that was staffed by some office help and a physician’s assistant.  In a stroke of good fortune, I was their only patient.  I was still there for an hour and 45 minutes while they diagnosed my broken bones, provided me with crutches and a nice fancy boot for a broken foot, and an appointment with a real doctor to confirm my brokenness.  Three days later I spent maybe 5 minutes with the Orthopedist who said I was doing everything I was supposed to and to keep it up for another 5 weeks.   A gentle pat on the head and I was sent away.  It was almost demeaning in a way.  I guess that is the price I have been made to pay by the depersonalization of our health care. 


Not that I minded much.  The doctor didn’t have to spend very much time with me.  I would have felt better if he had, but there was really no reason to do so.  There was no question that he knew what he was doing, and clear to him that I was doing what I should be doing and should continue to do.  We were done, but I still would have liked some professional sympathy.  Apparently, my private health care dollars don’t pay for sympathy.


Of course, these days health care spending is very expensive and out of control – out of reach for a lot of Americans.  This is just the kind of thing that falls under the governmental care that our forefathers so thoughtfully wrote into our constitution’s preamble in the phrase “promote the general welfare.”  This little phrase does not require socialized health care, but it does demand some reasonable solution to control the escalation of costs.  Health care spending is out of control for a whole bunch of reasons.  It is the kind of thing that we expect our government to fix, but that seems unlikely. There are many things to blame, and not very many palatable ways to fix it in a capitalistic economic system without seeming cruel and arbitrary, not to mention the ever popular sobriquets of racism, bigotry, other name calling, and miscellaneous slights from their constituency that keep our politicians from dealing with real economic problems. 


In a simpler time, we trusted our doctors.  We trusted them to have done all their research and know which illnesses were fatal and which we would survive, which drugs could help us and which could hurt us, which pains led to appendicitis and which led to the flu.  We did not question their judgment.  There were important maladies that neither the tincture of time nor bed rest itself could cure, and our doctors did their best to diagnose and provide us with the best care they could.  We paid our doctors as we needed them, and though they made more money than most, they were still affordable.  Doctors made house calls.  Life was simpler.  Then we learned to watch TV.


In a simpler time, there were no HMOs, or PPOs, and clinics were small self organized offices.  Hospitals were small providers of specialized care, not big businesses.  Health insurance was affordable, but hardly needed.  If you were really risk averse, you might have purchased a policy for “Major Medical.”  It would have been no more expensive than most people’s Starbuck’s budget for the month in this modern day. 


In a simpler time, there were no advertisements on TV for prescription drugs.  Television was black and white.  It was reserved for local news shows, cartoons on Saturday mornings and movies with good guys and bad guys, or with cowboys, horses and the occasional Indian.  Now we are assaulted with all sorts of colorful, informative advertisements that send us to our doctors demanding certain medications that we know we must have because the television has told us so.  We demand allergy medicines, flu shots, pills for our blood pressure and our cholesterol levels and our ulcers and our regularity and our post nasal drip and our dry eyes.  We demand pills to help us sleep at night, or to feel better about ourselves in these most uncertain times, or to calm our hyperactive children, or to lose weight, or to have better sex, or to alleviate our natural aches and pains.  We do this because we crave the simplicity of the uncomplicated and healthy lives we see on TV without the pain of earning an uncomplicated or healthy life by eating well and exercising.


We demand these things from our doctors and because, well, time is money and we don’t have the time to be sick and they don’t have the time to waste on the education of their patients. It is so much simpler to just give us what we want.  Our doctors have sought shelter in great assemblages of doctors and they generally give us what we ask for…because it is easier and less time consuming than arguing with us about appropriate patient care and drug protocols.  These doctors work normal 9 to 5 shifts in large hospitals and institutional clinics where the terms like HMO and PPO abound.  The term “house call” has been dropped from the vernacular.


In a simpler time, we had doctors and nurses.  Now we are seen by physician assistants who are well meaning, but neither as educated as a doctor nor as fulfilled in their vocation as a nurse.  They consult with real doctors when their patients present with more than a simple cold.  They are kind of “tweener”…an economical response to patients that want to dictate their own course of care.  They don’t get paid as much as doctors, but serve as a useful front line of defense to keep doctors from squandering their real doctoring on patients that just have the flu, or just have a cold, or just started running a fever.  The fact that most people try to put themselves in front of a doctor at the first sign of any physical discomfort is the most compelling reason for doctors to hide behind their assistants, and the most obvious indicator that people who prescribe a course of medical care for themselves don’t have a clue about anything but what they see on TV and should be dealt with at arms length.


It turns out that my physician’s assistant knew exactly what he was talking about. This was simply confirmed by the more time constrained, more expensive orthopedist who obviously had bigger bones to pick than my poor metatarsal.  I wasn't paying him to be empathetic.




So I’m talking with a little old church lady, Miss Sally Mae, about my broken foot and the inconvenience of crutches.  There are a couple things you need to know about Miss Sally Mae. 1) She was a red hat lady before there were red hat ladies.  She wears anything bright and spangled.  She has sequined ball caps and gold glitter tennis shoes, and wears earrings the size of hub caps.  2) She broke her pelvis about 5 years ago and carries a cane with her now wherever she goes.  (I think that has more to do with a litigious legal history than her ability to walk without it.)  She does not use the cane; she carries it like she’s leading a dog on a leash.  There is no wear on the rubber tip.  She decorates it seasonally as is her fashion.  She and her cane are quite the pair. 


Her conversation with me reminded me of the 1970’s movie, The Graduate, with Dustin Hoffman.  In the opening scene, Dustin has just graduated from college and is at a pool party thrown by his parents.  All the guests are family friends, but mostly business associates of his father’s.  A few of the men speak with the new graduate and give him a wink and a sly elbow nudge while whispering the word “plastics” into his ear. “Plastics” being the wave of the future.  Anyway, Miss Sally Mae and I are talking about my foot and I told her that I never thought I would say that I was going to be happy to get to walk with a cane in a couple of weeks.  She leans into me and with a conspiratorial wink and a quick glance at her cane, she says, “reflective tape.”  I can hardly wait.


This brief brush with our medical care delivery system brought to my attention an article in the paper the other day.  The state of Texas spent over $3 million caring for only three, otherwise healthy human beings who, over the course of three years had visited the emergency room of their local hospital on an average of once a week.  Each week these people felt they had a need to receive medical care of the highest order.  Each week they showed up in the emergency room with ill-defined complaints, and each week they received a battery of tests and visits from assorted medical personnel.   Each week their bills were 5 to 6 thousand dollars.  Now I realize that this is an extreme example of run away health care expenditures, but I’m wondering if they sort of felt like I felt in the Orthopedist’s office and just wanted some professional sympathy.  I missed not having received it, but I don’t actually regret that I didn’t get any.  Now if we could just get that sympathy product advertised on TV….

© 2009 Mark Indermill - All Rights Reserved

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