The Bishop and the Butterfly: Murder, Politics, and the End of the Jazz Age
    Deadman's picture

    Let's Get (A Real) Physical ...

    Earlier this week, I went to my doctor to get a physical.

    What a joke.

    Nurse came in, took some blood and, because I have a heart condition, administered an electrocardiogram (EKG). After a few minutes, doctor entered, looked in my ears and mouth, listened to me breathe for a bit, asked me a few questions about my general health and the back/leg pain I was experiencing last time I saw her, and then sent me on my way to deposit some urine and check out. All in all, it took less than 25 minutes from the time I entered the doctor's office to the time I paid my rather exorbitant $35 co-pay, and that's including the waiting time.

    Sometime early next week, I will get the results back from my blood and urine tests, and the numbers will all likely come back within the 'normal' ranges, suggesting I am the rather healthy 35-year-old male I appear to be.

    But the question will remain, am I really healthy??

    I firmly believe we will one day soon regard the current diagnostic procedures and preventative methods of our health system as incredibly rudimentary and insufficient. I mean, people tend to get their cars checked out with much greater detail and frequency than they do their own bodies. Airlines inspect their airplanes after every flight, and the most we do is get a doctor to take a quick look-see at us every so often (and maybe get the occasional mammogram or colonoscopy when we get a lot older)?

    It makes no sense. The no. 1 killer in the world is cardiovascular disease, and cancer is expected to overtake the top spot by 2010, according to the World Health Organization. In both diseases, early diagnosis is an extremely important factor in determining whether treatment is successful, and yet symptoms often don't appear until it is too late. How many people have you known or heard about who seemed perfectly healthy, only to find out later they suffered a heart attack or developed late-stage cancer?

    We spend billions and billions of dollars every year on cures and medicines for all sorts of diseases, many of which end up being ineffective ... when an earlier diagnosis would often result in much simpler, cheaper and more effective treatment options.

    If only we could develop a safe way to comprehensively examine our internal systems on a regular basis, to see if tumors are spreading, arteries are clogging, etc.

    Oh but wait! We pretty much have done just that...

    Magnetic Resonance Imaging machines, or MRIs, actually do take detailed, accurate pictures of a person's entire insides. Unlike X-Rays or CT scans, which use radiation to complete a similar function, MRIs are generally considered safe (if a bit difficult to endure for anyone who's even slightly claustrophobic). Yet despite the MRI's impressive capabilities, they are still only used after symptoms present themselves and even then with some reluctance because of their high cost.

    Around a decade ago, private clinics started popping up all over this country, offering full-body scans using either CT or MRI technologies. Given Americans' obsession with fighting aging and staying fit, you'd think these clinics would have done quite well. Yet they started going out of business almost immediately, thanks in large part to the high cost of the machines (several million dollars) and the uninsurable exams ($600 to $3000), as well as some extensive negative lobbying by traditional health care providers, including an HMO industry that was likely very worried they would one day be asked to reimburse patients for these tests.

    The full-body scans were unnecessary and dangerous, most health-care experts argued, saying that in addition to the radiation of the CT scans, the tests don't accurately diagnose all diseases, resulting in a lot of false negatives as well as false positives.

    False negatives can certainly lead to unhelpful patient complacency, but since cost is what drives almost every medical decision nowadays, I'm guessing it is the false positives and all the subsequent expensive and invasive follow-up tests that most disturb the insurance companies.

    But meanwhile, the technology in an MRI machine has since gotten a good deal more powerful and effective. Could it be that the early diagnosis of treatable diseases would end up saving the health industry money in the long run?? Has anyone done a detailed study on that cost/benefit equation?? And what, exactly, is the 'cost' of a life, anyway? Shouldn't that matter??

    A German university did a study a few years back where they gave full-body MRIs to 298 'healthy' patients and found something 'relevant' in 169 cases, 75% of which were confirmed by follow-up exams. Among the problems discovered included twelve colonic polyps, nine pulmonary lesions, and two previously undiscovered heart attacks. Twenty-one percent of the patients demonstrated atherosclerotic disease, while 12 percent had peripheral vascular disease.

    Only one false positive was found in the study. And yet the researchers still concluded that full-body MRI scans 'should not be performed outside of a research setting due to the uncertainty of whether the benefits outweigh the risks.'

    Like I said, what a joke.

    Comments

    I've mentioned this elsewhere, but I lost my dad a couple of years ago.  I have to be in the mood to talk much about the details.  I'm really not in that sort of mood right now, but I will say this: One of the most important things that I learned through the experience, the one thing that I would want to share with every person in America, is that you need an advocate in this system.  If you can do that for yourself, then do it.  If you can't, find someone who can.  Friend, family, anyone who can help advocate on your behalf.  You simply won't get the care you need unless you demand.  I consider this to be a systemic problem, and not a problem of the complacency of individuals.  I met many, many wonderfully talented and dedicated people that do jobs that I simply cannot do.  However, you have to find them and empower them to help you.  That's part of advocacy, too.  The bottom line is that the system is not designed to seek out the sickest and give them the best care.  It just doesn't work that way, even for the terminally ill.

    If you know someone who can't do this for themselves, help them or help them find someone who can if you're unable.  If you are in this situation and can't do it for yourself, try to find someone who can help.

    I think that what you've brought up about diagnostics is meritous, but I really don't want to think about this any more right now.  I'm sorry.  It's a point worth raising.


    I have heard so many horror stories, and it pains me to hear about yours, there is no doubt I feel our health care system is indeed in need of an overhaul.

    I think that's a great point about being an advocate - so often, I keep quiet because I feel like I'm bothering a doctor or don't want to make a stink. But health isn't something to be trifled with, and we are paying top dollar for our care and should demand the best.

    I still think the system woefully neglects prevention and diagnosis as an important way to save money and lives.


    This issue is such a minefield, isn't it. I get so angry at the health care industry, when dealing with them for myself and when dealing with them for my mom. Deadman is right that we should be using the technology we have to save money in the long run but insurance companies, and especially the government programs like Medicaid and Medicare, are so short-sighted about the cost savings to be had simply by emphasizing prevention.

    Also, the nursing home industry is an absolutely disaster. There are good places and good workers out there, but the system is so screwy. The first place my mom lived was so great. I felt so lucky that we found it for her. But when we placed her there, she was really sweet and even tempered. She never talked and she smiled a lot, and everybody loved her. Then, she started to have what they call "behavioral issues" associated with the Alzheimer's. And the nursing home pushed her right out the door, because they didn't want her around hurting herself or possibly other patients. Instead of getting her help, they got rid of her and it was 100% in their right to do so. At the time, I had no idea what was happening because I was operating under the assumption that they were acting in good faith. By the time I realized what was going on, it was too late to stop it and it lead to an almost-nervous breakdown for me and a new home for my mom that is far away. But, now I know what questions to ask and how to find advocates, so when the behavior problems started again, like I talked about in my post a couple weeks ago, I was able to deal with it quickly to make sure she was being cared for appropriately.

    For me personally, the worst part is trying to get medication. Twice this year, my insurance company refused to cover the medication my doctor was prescribing until she prescribed an alternative that I could try first. I read up on all the alternatives,and the didn't cover what the medicine was for. I tried to be convincing on a phone call to the insurance company, but that was pointless. I ended up basically telling the insurance company rep that I thought she must be really smart to sit at a desk and be able to know what medicine I needed when my doctor who has seen me for over five years and went to school for at least 8 apparently made the wrong decision. It wasn't very productive, but it felt kinda good. 

    Edit: I forgot to mention that the end result was that I was so frustrated that I didn't fill the original prescriptions and I didn't try the alternatives. For me, it was just allergies, so it's a matter of irritation. But how many other people have the same experience with more serious helath problems that are made even worse by lack of treatment?


    I think we can all agree that the insurance companies border on being evil. Throughout the health care field - from doctors to pharma to HMOs (with the possible exception of nurses) - the lack of compassion is stunning, but certainly the insurance companies are the worst of the bunch.