Medical Patient Beware

As I've gotten older I find myself observing and thinking more and "being entertained" less. Accordingly, this blog entry will depart from my usual. It will deal with the state of our medical system. I will relate some personal examples and question some common beliefs. In this part I will look at the impact of universal medical insurance and in the next part look at the deaths and other troubles caused by medical mistakes.

First, a disclaimer. I am not a doctor, nurse or medical technician and have no medical training other than basic lifesaving techniques that I received in the Army. I do read about a wide range of subjects. I also observe the popular media with the widening range of commercials for pharmaceuticals and medical appliances.

During my time serving in the US Army I had adequate medical care although I seldom needed to take advantage of what there was. After retiring from the Army and as a natural consequence of aging, I've found my body needing and using more medical care so I've been paying more attention to this situation.

I have never expected to receive medical care that compares to that received by upper level politicians, leaders of industry or the wealthy people in our society. I have expected, however, to receive adequate care that meets the standard of the old aphorism, "First, do no harm."

My medical care generally has been pretty good, but there have been a few exceptions, which prove to me, and I hope to you also, that it is incumbent on all of us to be vigilant. Double check prescriptions; request copies of your medical records and check them for accuracy and if you don't understand or aren't sure about prescribed treatments, question the doctor.

TOO MUCH INSURANCE?

In this part, I’d like to examine the hidden costs of “free” medical care. Nowadays many people think such cost-free (to the patient) coverage is a “right” and everyone should be entitled. Sometimes I wonder if complete medical insurance coverage is really a good thing.

About ten years ago, I was troubled by pain radiating back from behind the small toe of my left foot. I was referred to a podiatrist who X-Rayed, poked and prodded and gave me a cure.

"This bone," he said, tracing the bone that connects the joint of the small toe to the rest of the foot, "has spread out too far, causing the pain where your shoe pushes on it and we need to operate. I'll make a V-shaped cut in the bone, bring the front of the bone back where it belongs, wire it up and when everything heals you'll be as good as new."

I asked him how much would cost. Says he, "Oh, don't worry about that, your insurance will cover everything."

When I asked if there were any alternatives to operating, to his credit, he did say, "You could wear wider shoes." and gave me the names of a couple of manufacturers who still make shoes sized for width. I've been wearing wider shoes and haven't had the pain recur since. 

A similar situation occurred five or six years ago with another consulting doctor where I was referred for possible treatment for strabismus, commonly called crossed eyes. In my case, one eye tends to look up and the other, down. As I've gotten older, the problem has gotten worse so now when my eyes get tired, I see double. 

One solution for this problem is to prescribe prisms for a person's eye glasses. In my case, I was started with a prism of 2.5 up in one eye and 2.5 down in the other to compensate for their tendency to wander. As time went by, I progressed (or degressed) to 3 up and 3 down, and with the most recent prescription, it has gone to 3.5 up and 3.5 down. 

This is a practical and inexpensive treatment for the problem. The prisms don't cost more and their effectiveness in compensating for the pull of the eye muscles is relatively good. But the consulting ophthalmologist had an even better solution. In each eye, he would relocate one of the muscles that control where that eye looks, thus pulling the eye back into alignment and saving the need for prisms.

He made a very enthusiastic presentation of the benefits of the surgery and, again, came that reassurance that, "There was no need to worry about cost since it will all be covered by your insurance." I told him I wanted to think about it. I researched and found that it is very effective when used on babies and young children but with adults, especially older adults, the brain soon returns to its pattern of interpreting the data from the eyes and another operation is needed to move the muscles even further. Or, you again wear glasses with prisms. 

A few days later, the doctor himself called me early one evening and wanted to know when I would be in and if he could schedule the operation. When I questioned him about the efficacy of the operation, especially on older adults, he did moderate his enthusiasm but still wanted to schedule me in. Told him I would wait. He called back one more time, again wanting me to schedule an operation. This time I told him a flat, “No.” Later, I complained to my regular optometrist and she said that particular consulting ophthalmologist had been removed from the referral lists. 

I relate these two examples because, first, they actually happened to me and, second, they illustrate the problem of universal insurance, as I see it.

Many people, presented with this kind of situation, would say, first, “It’s free, so why not?” and second, “It might help,” and third, “The doctor recommended the operation so it must be good for me.”

But, not so fast. Anytime a doctor sticks a knife in your body there is danger of unwanted results.

It’s difficult to find good data, but the current best guess is that 1.14% of patients who go into the hospital for surgery don’t leave alive. Based on 50 million surgeries, that’s about 570,000 deaths per year.

Bacterial infections after surgery also cause problems. As the Johns Hopkins site says:

Your skin is a natural barrier against infection. Even with many precautions and protocols to prevent infection in place, any surgery that causes a break in the skin can lead to an infection. Doctors call these infections surgical site infections (SSIs) because they occur on the part of the body where the surgery took place. If you have surgery, the chances of developing an SSI are about 1% to 3%.

Taking a mid-range figure of 2%, that’s about 1 million infections per year. http://www.hopkinsmedicine.org/healthlibrary/conditions/surgical_care/surgical_site_infections_134,144/

If that’s not enough to make you carefully question a recommended surgery, there is also the increasing number of infections from bacteria that are resistant to antibiotics. US Center for Disease Control (CDC) estimates at least 2 million people become infected annually with bacteria that are resistant to antibiotics, and at least 23,000 people die as a direct result of infection. Of course, not all are a result of elective surgery, but many are.

And there are anesthesia complications (. . .anesthesia/anesthetics are reported as the underlying cause in approximately 34 deaths and contributing factors in another 281 deaths. . .) (from NCBI, The National Center for Biotechnology Information).

If they see equal outcomes between operating or not, doctors, even the most altruistic, might be swayed by the bottom line. Less altruistic doctors, as in the cases above, may put their thumb on the scale in favor of operating because they want the money. As we’ll see in the next post, the occasional doctor seems to be in the business only for the money.

Patients are motivated by money also. In many cases I think the “buffet lunch syndrome” comes into play. People think, “Well I’ve paid my deductible,” or “my insurance covers everything,” and like the diner at a buffet lunch or a passenger on a cruise ship, they want to get as much as they can because it’s “free.”

I also see this in the media where the commercials often say, “This battery driven wheelchair (or back brace, or whatever) is available at little or no cost to you,” playing on the desire many people have to get something for nothing, really needed or not.

So just because it’s “free,” “might help,” and “the doctor recommends it,” I recommend you think at least twice before having a doctor cut into your body. Think once about the possible problems and think once more about the pull of money, both on the doctor and also on your own motivation.

This post has grown as I’ve been writing. I will end this part here and in the next post take a look at medical mistakes. I’ll cite some personal examples and make some more recommendations.