Monday, September 25, 2006

After All, It's Still A Business

After all, it's still a business.
These words still ring in my head.
He was a pleasant young man in his thirties. A bit of a worry-wart. But then again, with his medical history, who wouldn't be? He had his first myocardial infarct (heart attack) in his early twenties. Since then, he's had another 2. He's had so many angioplasties that he's lost count. The stack of medical records that came with him told of the 9 coronary stents he has. I didn't even know you could get that many stents.
Yes, he has a reason to worry.
His L_D_L was over 500 mg/dL (in his situation, should be below 70). Despite being on maximal doses of 3 medications to lower this. Familial hypercholesteroloemia*, refractory to the usual. In a last-ditch effort to lower this, we suggested L_D_L-phoresis. Think of it as hemodialysis for the kholesterol*. When I saw him next, his numbers were in the 200's. Still shitty numbers, but the best they've ever been, and very likely will impact his survival.
Until he called me recently, upset. His insurance company is now balking at the cost of the treatment, and will soon stop payments.
I wrote a very strongly worded letter to them. So did her other doctors. Without his treatment, there's a good chance he won't live into his 5th decade. But I'm not sure this will do anything.
When I confided to a mentor, who's seen this one too many times, he just sighed, and said:

After all, it IS still a business. These people make money out of the sick, or those who fear illness.

Healthcare isn't cheap. In the meantime, the physicians are helpless, while the sick die.
*Yes, I do know how to spell. Some words misspelt intentionally to avoid inadvertent Googling.


Anonymous Anonymous said...

I certainly don't think business and medicine make ideal bedfellows. I am appaled by the way lots of people have no access to healthcare in the USA. It is estimated that up to 46 million americans, or almost 16% of the population have no access to healthcare. I personally believe that basic healthcare (including emergency services and child health screening) should be available to everybody, such is the provisions in most European countries, Scandinavia, Singapore, Canada and a few others. I think, being a capitalist country, America has the wrong ideals about healthcare. How can the Americans rave about the standard of care when so many children go without health screening and emergency services are denied for the people who arguably need it the most?!

10:36 AM  
Anonymous Anonymous said...

agreed. though emergency services are given even to those without funds.


11:14 AM  
Anonymous Anonymous said...

Well, I'm not too sure of that, I have read numerous reports where people who are critically ill have been turned away from hospital just because they don't have medical insurance or some sort of guarantee of payment. Still i think it's something to be sorted out.

1:45 PM  
Blogger vagus said...

i don't know about those reports. our code of ethics would not allow a hospital to not treat emergency cases and there would be legal implications if they didn't.
maybe just isolated cases.
but, patients not getting the best treatment because of lack of funds is definitely prevalent.

4:22 PM  
Anonymous Anonymous said...

I agreed that we don't have the perfect healthcare system but we as physicians still do try our best to provide quality healthcare to our patients.
We just have to work with the current system until we can figure out a better way to do it.
I first came to country as an IMG(international medical graduate), then decide to stay here after my medical residency.I still enjoy practising medicine here even though there are challenging work at time.
I agreed with Dr Khoo that emergency services are always provided regardless of funds.But for the uninsured, getting non- emergency care in a free or county level clinics in a timely manner is challenging because of the ever increasing need for medical care.

1:57 AM  
Anonymous 2nd anonymous said...

Just to clarify thing a little for your reader,I'm the other anonymous person that post the previous message which should be the 2nd anonymous.

1:23 PM  
Blogger vagus said...

Gaahhh. Too many Anonymouses. I'm confused! :)
Where are you based anyway, Anonymous 2? Do i know you?

2:01 PM  
Blogger PaulOS said...

anonymouses-annoying? :P heh heh

All chain effect mah..
Greed.. Greed.. Greed

Insurance Healthcare is greedy want to collect money without paying it out

Fast food is greedy... cheap grease... more coronary heart disease

Pharmaceutical aparatus and drugs.. exorbitantly priced.. greed again..

Who gets squashed.. the puny little man.. who just wants to live a decent life.

Why can't healthcare be reasonably priced so that all can get equal treatment? *sigh*... aren't we all human beings with the right to live equal quality of life..?

9:09 PM  
Anonymous CK Lau said...

I came across your blog through Dr Chen's blog one day.Kind of interesting how all this get started. I was seaching on the web one day regarding my old hometown in the Bolehland.Got link to Dr Chen Med/food blog as she is from my hometown.Then, I found all this interesting med blogs and I started to follow them often. It's certainly nice to know all this thing back in Malaysia even though I no longer live there for the past 20 plus years.
Left my original home country in the early 1980's after my upper six.Finished med school and internship in Taiwan before I came to this land of equal opportunity.I did my internship and residency in San Francisco and now in private practice in the Bay Area.I love the Bay Area and like many immigrants from other countries, we(me,my wife and 2 kids) make it home in California.
I hope you too enjoy your years in North America.

Anonymous 2

1:14 AM  
Blogger Palmdoc said...

The MMR comments:
When the insurance company won’t pay

6:26 PM  
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