Walnut Room this way

Walnut Room this way

Thursday, August 30, 2012

What's wrong with health care in the US?

If all businesses or services operated like a doctor's office, they would soon be out of business.  Where else can you have an appointment for 1:30 and be seen by the doctor at 3:00...for less than 5 minutes for the cost of $210?  I am telling the absolute truth, with no exaggeration.  When I was in private practice as a therapist, there is no way I could have made an appointment for a client at 1:30 and think he or she would still be sitting in my waiting room an hour and a half later, or return for services.  And yet, that is the routine in almost any doctor's office nowadays, and they think nothing of it.

I was in for my annual check up a few weeks ago and my regular physician was most upset with me that I had not gotten a colonoscopy like he advised me to do last year.  Why did he advise it?  It has been more than 10 years since I have had one.  There were no findings at my first screening, and I have no risk factors other than the fact that I am now 10 years older.  Okay, so I yielded to his urgent recommendation and they scheduled me for a consultation for a colonoscopy.

I arrived at my appointment 10 minutes early, to allow time to fill out the paperwork.  I returned it to the front desk at 1:30--my scheduled appointment time.  Now, I am not naive enough to really believe that the doctor was going to see me at 1:30, but I really did think it would not be one and one-half hours.  The waiting room is full--about 10 or 12 patients in front of me.  Time drags on.  Finally, at 2:30, they called my name.  A nurse weighed me, took my blood pressure (and said it was high at 151 over something, which is basically impossible.  I have never ever had a reading of high blood pressure in my entire life under any circumstances, plus, I take a beta blocker for my heart arrhythmia which lowers my normal blood pressure even lower than normal), had me stand against a wall to take my photo for the electronic medical records (another scary idea) and led me down the hall to a room that was only about 2 degrees warmer than a meat locker.  She said, "Do you get cold easily?"  No, not usually.  "This is the coldest room in the building."  She handed me a brochure on colonoscopy, and the consent to treatment form and left me to entertain myself for the next half hour.

I am telling the absolute truth again--I swear it.  For the next 30 minutes (I know, because in my annoyance and semi-blue state from the freezer in which I was housed, I kept looking at my watch) I entertained myself by looking up "is a colonoscopy really necessary, and when?" on my iPhone.  You know what?  Turns out that it might not be.  I was on the National Institute of Health website, as when I do research, I really want real academic research, not "Joe Bob's One Stop Colonoscopy and Essential Oils and Other Holistic Health Care."  Out of the 9 studies I had time to read in those 30 minutes, every single one of them found anywhere from 25-33% of colonoscopies are inappropriate and unnecessary. As many as 50-64% of them are "uncertain" meaning we don't know if they were needed or not.  Not unsurprising, gastroenterologists are far more likely than an "expert panel" of physicians to say a colonoscopy is necessary.  In those unnecessary colonoscopies, very rarely did a screening reveal cancer.

So what are the criteria for a colonoscopy, other than a routine screening every 10 years after 50 and until 80?  (The physician explained that after 80, the benefit does not outweigh the cost, so they don't recommend them.  Why, because they expect you to die before you can pay for the colonoscopy, or just that you won't extend your life enough to make it worth the cost if you do have cancer?)

Risk factors: constipation, bleeding, diarrhea, pain, nausea, vomiting, history of colon cancer in family, positive blood occult colo-rectal smear. Nope, none of those.  In fact, no history of cancer of any kind on either side of my family, all of whom live to be in their upper 80s and upper 90s, barring a car falling on them, which is no respecter of age.

Just as I am really getting into this research, the door opens, and the doctor walks in.  He said, "Wow, you don't look 62.  So you need a colonoscopy?"  I don't know if I need one or not; Dr. X just thought I should have a consult since it has been 10 years since I had one.  So, I am consulting with you.  "At your age, and over 10 years, you need one."

That's it, folks.  No discussion of my family history, no discussion or questions about any of the risk factors that I do not have, or any suggestion as to why this expensive and time-consuming procedure is going to improve my life.  I just "need it" because I am 62 and haven't had one in 10 years.  Now, I get the need to have my mammogram every year.  I get the need to have my teeth cleaned every 6 months. But I don't get the need to have a colonoscopy with absolutely no history of concern, and my general good health, and the research results.

"When do you want to schedule it?  I do them on Tuesday mornings and Wednesday afternoons."

By 3:05 (Yes, I know, because I looked at my watch when I got in the car), I was through check-out, with a request to call and schedule my appointment (I said I would have to decide when), and a bill for $210 for a "screening consultation" that lasted less than 5 minutes, but for which I waited 1 1/2 hours.  A screening consultation for which I provided all the "screening" information, the doctor asked me no questions, and essentially disregards my question as to whether or not, or why, I need a colonoscopy just because of my age.  The research indicates that in colonoscopies when there are no symptomatic criteria, the screening rarely reveals cancer, polyps, or other disease.

I am a believer in preventative medicine, and I don't take unnecessary risks with my health.  I confess to struggling with this, remembering all the women with whom I worked at the community mental health center who would go to the state psychiatric hospital where pap smears and mammograms were required, receive a diagnosis of abnormality and in some cases, cancer, and then be discharged and unable to afford follow up health care because they had no insurance.  I on the other hand, have insurance that will pay the full amount for this "screening" to determine when (not if) I should have the procedure. (Note: My insurance will not pay the full amount on the procedure; that will require a $1,000 deductible and will pay only a percentage of the procedure).

If this process of health care doesn't bother the rest of you, consider the following:

  • In the World Health Organization rankings, considered reasonable by most health experts, 
  • the US ranks 37 out of 191 in overall health efficiency;
  • all of Europe, Japan, Iceland, United Kingdom, Columbia, Saudi Arabia, Canada, Costa Rica, Australia, and Chile rank higher than the US
  • US ranks only 2 above the oft-maligned Cuba
  • life expectancy ranks 29th, tied with South Korea and Denmark; Japan, is the highest, and Costa Rica, Chile, and Greece are higher than the US
  • the US spends 2 1/2 times as much per person than 30 other industrialized countries, and yet our health outcomes are among the worst
  • the best predictor of health in the US is whether or not you are wealthy.
The issue deserves serious research, reflection, and problem-solving in order to "promote the general welfare" of the people.


Gigi said...

Amen, sister!

Beth said...

Well said, thank you!