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The diagnosis you want or the diagnosis you need?

Ah, the US healthcare system. It’s so big and bloated and incredibly complicated. If I were to break a bone right now, I’d have to go to the ER, wait a few hours to be seen, wait some more to get an x-ray, wait a little more to get it in a cast. God forbid I need an orthopedic consult because that’s a few more hours of waiting. All the while, the physician would probably pump me full of pain killers and even give me a prescription for narcotics when I leave. If I have insurance, I’ll have to pay a copay and hope and pray that the rest of my visit is covered. If I don’t have insurance, I can look forward to a hefty bill from the hospital once this is all done. And then I’ll have to pay again to get the cast removed or to follow-up with my family physician (if I have one) or with the orthopedic surgeon.

And that’s just for a broken bone. God be with me if I were to suffer something more serious that requires an overnight stay at the hospital. That cost would be incredible on more levels than one. In short, the US healthcare system is broken… But it’s what we have. To fix it requires a lot of initiative and leadership that is lacking at all levels of government. The President pushed through his huge reform bill, pissing off everyone on the other side of aisle. It was so big and bloated (I keep using that word), that it will take years to implement, and I see first-hand in my work at the clinical lab that everyone is confused about it. On the other side, the Republicans don’t want to do anything about it because… Because… I don’t know. They just don’t want to do anything about it. Maybe because the “undesirables” would get the help they need to afford healthcare?

I see healthcare as a product. Like any other product, healthcare is subject to the forces of supply and demand. There is not enough supply and there is a lot of demand, especially as the population is growing. This causes the price of things to rise. Now, to make the price go down, we can either reduce demand or increase supply. To reduce demand, we would need to have less sick people. That’s a public health and prevention thing that would take a long blog post of its own to discuss. To increase supply, we would need more physicians, hospitals, emergency departments, urgent care centers, clinics, other healthcare providers (e.g. physician assistants), etcetera. Well, we already have those things. The problem is access. They’re either too costly (or don’t take insurance) or are in parts of a city/town that are inaccessible to the people who need them. That latter point is very present to me when I see the farmworkers that come to the clinic where I volunteer after a one hour drive in a van once a week, weather permitting.

But there is plenty of blame to go around beside the blame placed on our elected representatives and the bureaucracies they’ve set up to deal with all this. (Seriously, I still can’t wrap my head around the Social Security Administration, let alone the Veterans Affairs Administration.) There is also blame on us, the consumer. For quite some time now, we have been treating healthcare like a product. Yes, you read that right. After writing to you that I see healthcare as a product, I’m now placing blame on people for seeing it as such. No, I’m not (that) crazy.

As I’ve done before, the examples I’m going to give you are an amalgam of what I’ve seen in my different jobs as a lab tech, what I’ve heard from friends and colleagues in the field, and what people have told me they’ve experienced when going to the doctor’s. These examples are not one person or one case. Capish?

Painful customers

I heard from a friend who works in an emergency department that there is quite the steady stream of people who come in for aches and pains that would be normally treated with an over-the-counter non-steroidal anti-inflammatory medication like ibuprofen or acetaminophen. He says that these people come in and ask for narcotics and notes off from work because they can no longer deal with their pain. They were given narcotics when they were first injured, and the providers made a point of reducing their pain as if it was some other vital sign like temperature or blood sugar. Those narcotics took out the pain receptors, and now the patients are very sensitive to pain. In short, they built up tolerance to the narcotics. When my friend recommends that they seek care for that “addiction,” the people are indignant. They are A) indignant to be called “addicts” and B) indignant that the physician won’t do what they ask. After all, the customer is always right. How dare this “punk ass” (they’ve called him that) doctor not do as he is told?

Frequent flyers (or is it “fliers”?)

Another friend of mine is a nurse at a community clinic in the inner city of one of our great and wonderful cities. She tells me that there is a group of “frequent flyers” who come in time after time for the most minor of things. It’s not that they’re that sick. They’re that lonely. Or they have mental health conditions that make them come in for things that would otherwise be considered “silly,” like “crawling skin” or “very dry mouth.” Or they are alcoholics who feel sick in the morning after a bender or are sick because they’re trying to quit cold turkey. And don’t even get her started on the people who come in for “phantom” erectile dysfunction, where the patient thinks that not being able to go at it again within minutes of having sex at the age of 40 means that they’re somehow broken. (That all ends when you’re around 28, bro.)

“I’m good to go!”
Photo credit: keoshi / Foter / CC BY-NC-SA

Things preventive care would have, uh, prevented

Then there are the patient who come in for diseases and conditions that are totally preventable, like sexually-transmitted infections, vaccine-preventable infections, high blood pressure secondary to obesity, tooth caries, and even some things associated with malnutrition. (Big Mac value meals, astoundingly, do not supply your daily dose of vitamin C, scurvy boy.) I kid you not when I tell you that I have seen children as young as three be brought in by their parents because they have tooth cavities. And by “they” I mean the whole family. They’ll be sitting in the waiting area before they’re taken into a room, and all of them will be holding a container of soda. As a “big” guy myself, I can’t poo-poo much on people who are morbidly obese and thus have high blood pressure and diabetes. On the other hand, as someone who keeps going out for runs and is fighting his weight all the time, I can and will go ahead and poo-poo on them. (Dude, you’re 425 pounds and 5’5″, skip a meal, go for a walk.)

No, I won’t go for a walk, and you’re going to treat my diabetes.
[do action=”credit”]Photo credit: Tobyotter / Foter / CC BY[/do]

The diagnosis you need

Finally, there are the people who think that every provider is a pushover, or they shop around for a pushover, and ask for a diagnosis that they need. They need it to get off from work, to get insurance coverage, or to get money from someone after an accident. (Tort reform is something we desperately need to bring healthcare costs under control as well.) Like the people who don’t get the narcotics they “need,” these people will also get indignant and file complaints. Every week, I hear about one of my friends and colleagues in healthcare getting “in trouble” because they didn’t go with a patient’s request for a certain medication (e.g. antibiotics) or a diagnosis. And I’m not saying it because they’re my friends, but these providers are very capable people. They take their job seriously, and they’re not pushovers. That’s why they get complaints filed against them.

It’s sad, really.

To conclude

I would like it very much for our elected officials to put their differences aside and really come up with a way to fix all this. They need to make healthcare available to all, thus reducing the demand and increasing the supply. They need to get outside of their little boxes and do something about the wave of people coming at us and at the system with chronic conditions. Of course, this is much easier said than done. The Senators seem to be able to talk to each other and come up with compromise more often than not. After all, there’s 100 of them. The Representatives… My God, they’re a mess. It’s 435 of them yelling past each other, peddling to the whims of the fringes of their electorate, and not really coming up with anything useful. Instead of finding a better way to do healthcare reform, they keep holding votes to repeal it completely.

And then there’s us, the consumers. We want the doctor to do what we say, not what they’ve been trained to do. We Google something and think that we know all about it. “My throat is sore, it must be throat cancer,” we say because that’s the worst-case scenario. “I have a urinary tract infection, can you give me something for it? I have a hot date tonight,” we say when we want immediate solutions to what is ailing us. And we forget that healthcare workers are human and bound to make honest mistakes, so we sue them for millions for what would otherwise be an annoyance and an interesting anecdote to tell the grandchildren.

In short, we created this mess, we contribute to it, and we expect someone else to fix it… Just like we do with what ails us.

[do action=”credit”]Featured image credit: Seattle Municipal Archives / Foter / CC BY[/do]

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René F. Najera, DrPH

I'm a Doctor of Public Health, having studied at the Johns Hopkins University Bloomberg School of Public Health.
All opinions are my own and in no way represent anyone else or any of the organizations for which I work.
About History of Vaccines: I am the editor of the History of Vaccines site, a project of the College of Physicians of Philadelphia. Please read the About page on the site for more information.
About Epidemiological: I am the sole contributor to Epidemiological, my personal blog to discuss all sorts of issues. It also has an About page you should check out.

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