Thursday, October 19, 2006

Thinking about U.S. healthcare


I hardly could be thinking about anything else. I spent most of yesterday at a teaching hospital attached to a highly regarded medical school helping a friend get through a batch of high tech tests. She was poked, stuck with an IV, infused, irradiated, imaged -- and finally fed to raise her blood sugar lest she collapse mid-test. The people who worked on her -- nurses and nuclear medical technicians mostly -- were considerate, thoughtful and cheerful.

And yet -- I find it hard to believe that what happened there was necessary. I'm no doctor, but please bear with me while I try to apply common sense to what I saw.

A little background: my friend reminds me of Job, a person visited with affliction after meaningless affliction. Some years ago she was in a car accident and was thrown through the windshield, suffering numerous broken limbs and some brain damage. She was hospitalized for nearly a year. She emerged severely disabled and, naturally, being unable to work, ended up living on the pittance that is Social Security Disability Insurance. She gets the medical attention the state in its wisdom offers the indigent. She has developed both asthma and COPD, what we used to call emphysema. She breathes oxygen 24 hours a day. Her mobility is severely limited by pain of multiple sorts, some undiagnosed. Not surprisingly, she is severely depressed and has become grossly obese. That is, she is a living, suffering creature in pain. She takes vast numbers of prescription medicines.

Somewhere in all this, a pain specialist became my friend's primary care physician. The guy really wanted her not to hurt so much, as all of us do who can see through her misery to her wisdom and charm. But as he rose in his profession, he stopped seeing patients, so has been transferring my friend to another doctor over the last year. The New Doctor inherited a four-volume history and, since she is attached to a high tech medical center, wanted yet more data. You'll note that the previous description doesn't report any circulatory or heart problems. This woman's heart seems to be plunking along well enough to keep her around to suffer the rest of her maladies.

But New Doctor wanted to know all the lay of the land. So my friend, who mostly is quite cooperative with doctors she feels are on her side, had to go through yesterday's procedures. When you are enormous and can barely move around, being stuck and strapped into smallish machines that take pictures of your insides is agonizing.

And presumably all this high tech stuff costs a pretty penny. Perhaps $5000 will be billed somewhere?

What in the world is New Doctor going to do with the information? Give her more drugs for her heart? My friend already takes such a melange of prescriptions that she's something of an experiment in drug interactions.

Everyone involved in what I saw yesterday seemed to be doing their best to do something good. But the system seems broken, warping the effects of people's best intentions. This is not a story of failure of access. My friend gets doctoring, sophisticated doctoring. Rather, it is a story of failure of care. It is about medicine divorced from the healing. Somehow this country has created a crazy quilt "system" that has more distortions than paths to recovery. Can't we do better?

2 comments:

sfmike said...

This is where you needed to step in and say "no, you're not putting my friend through that, sudden heart failure might be a blessing so get f---ing serious." If your insurance is too good or you happen to fall into the right sort of disability category, you will be tortured with everything high-tech hospitals (particularly teaching institutions) have to offer. If you're middle-class with crummy insurance, you'll probably have the opposite problem where getting serious preventive care is disallowed by the insurance gangsters who currently gouge the system.

What is needed is a friend and an advocate and a plain old warrior just to get through the horror. Good luck, Miss Jan.

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