Sunday, August 28, 2011

It's a Mad Mad World

Some things are so screwed up.
For one, healthcare and medicine are f*cking expensive. Doctors' visits ain't cheap (and no, I don't get to choose the dollar amount I charge. We just code according to 'complexity' of the case) and the amount that gets charged depends on the health insurance and bureaucratic BS that I don't fathom. Secondly, the medications themselves are overpriced, really. I understand the need to cover costs of R&D. But to be making billions seems wrong.

I guess I'm just irritated with things. I saw a patient the other day for poorly controlled diabetes. She has type 1, a condition that requires lifelong (until someone comes up with a cure) insulin and regular glucose testing to allow for safe adjustments of her insulins. Unfortunately her hemoglobin A1c was 14%, her control hampened by lack of compliance. Except I don't blame her.
Tearfully, she tells me she just cannot afford the glucose strips, and the insulins. She is one of the millions of uninsured Americans. And so, medical care costs a bomb, and she has had to decide what's more important, food/rental or medications.
And so, I squirrelled away whatever free samples I could find in the clinic. And referred her to the social worker. And, hoping the hospital director never finds out, bills her a level 2 (with the multiple issues and her high risk situation, this would have been a level 5). Essentially, something akin to a nursing visit. The last time I did this, I got a reprimand.
Elsewhere in the world, if a doctor, in good faith, decides to undercharge a patient, it's his perogative. Heck, in Malaysia I've had doctors who give courtesy 'free consults'. Here, in this overly civilized country, that may be perceived as a form of discrimination. Why would you give a discount to one patient, and not another?
And so, the hospital and it's lawyers go nuts with these things. And it is very frowned upon, as tragic as the case may be. The hospital does not wish to open itself to any lawsuits.
In my opinion, if we weren't afraid of being sued, healthcare in general would be much cheaper, and the world would be a better place. Without the threat of lawsuits, that may make some idiots be bigger idiots, but I'd like to trust that mankind generally, is good.

If we weren't so careful and afraid of missing somethings, things would be so much simpler and cost effective. Ie, make a medical decision based on the history and the clinical findings and suspicion, and go with it. And not "run other tests to make sure I'm not missing something" defensive medicine that the malpractice lawyers have made American medicine to be, these days. I mean, come on, do all tummy pains require a CT abdomen?

And all that "If you've taken Pill X and have had an adverse effect of Y, call Lawyer Z as you may be entitled to a monetary compensation...". ALL medications have side effects. All of them. You take a pill if you and your physician agree that the benefit far exceeds that. I get pissed seeing the new TV ads for people who had a heart attack while taking a certain pill; chances are without that medication MORE patient would have died from their medical condition.

You tell me, is this not screwed up?

We'll see if I get a call from the director about this case. Frankly, I don't care.


Anonymous Anonymous said...

Vagus, I admire your determination to stand up for what you believe in. Unfortunately, the Western world is governed by policies which are too rigid.

4:22 PM  
Blogger huajern said...

Healthcare in Malaysia is slowly but surely going down the road of excessive investigations. Though here it may be more due to profit reasons than lawsuits. The 'limited' investigation route is seen in govt hospitals by default, where we can't get the test rapidly. Sigh.

9:53 AM  
Anonymous Anonymous said...

this is why you need socialised healthcare.
in the OECD countries they are governed by rigid policies which ensures that corruption is at a minimum and there is accountability.
but unfortunately america is just a strange country compared to the other OECD countries.
the rich just make too much money and the poor and middle class instead are marginalised.
and apart from that, tax rates are too low for the rich and they do not want to see "socialism" of anything at all.
first of all, i don't even think they understand what socialism means.
and while Msia healthcare might seem "better" to you, but when crunch time comes, would you be willing to send your loved ones to government hospitals that have substandard healthcare? or the rip off private hospitals who charge so high yet but have somewhat better care?

2:22 PM  
Anonymous Anonymous said...

Ah, the age old debate! Healthcare can be affordable, fast, universal. You just have to pick 2 out of the 3! There is no such thing as the perfect healthcare model. Wherever you go there are always complaints, the trick is to find the best solution to suite the popultaion. Having worked in the UK, US and malaysian healthcare models, if I had to pick I would probably choose the UK model. It may not be fast, but it's affordable and universal. The USA spends the most on healthcare per capita and the outcomes are no better than other developed countries. Also, litigation is a real and very worriesome problem which is driving up the cost of healthcare. Healthcare is no longer a profession, it is now a business. Throw in the millions of under and uninsured patients and it all spells for a disaster. Personally I'm packing my bags and moving to Australia! As for underbilling, that's just plain fraud!

6:03 PM  
Blogger vagus said...

Good points. There is no perfect system.
Socialized healthcare isn't all that some make it to be; I trained in one. People take advantage of it- going to the ER for non-urgent issues. The system gets overstretched- a classmate waited 3 months for an MRI, just because it was deemed nonurgent.
So, I'm not sure what the best system is, frankly.
But Australia sounds nice, though :)

6:24 PM  

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