Health care

Over at Quora, someone wondered why it is that when you show up at an emergency room, none of the staff seems to understand that “emergency” means “urgent.”

A number of medical workers were quick to explain that the “emergency” in “emergency room” does not mean “urgent,” and that if you don’t have a life-threatening condition, you have to wait until they get done dealing with people who do. And that certainly is true: who would want their stubbed toe or their broken arm treated ahead of some soul with a heart attack, a stroke, or a gunshot wound?

All of us can understand that ER workers are stressed to the max and that they have to make quick decisions about who needs care and when. But…

Back in the day before ACA, poor people here used the ERs for medical care whenever their kids had a bad cold or flu and for conditions adults and children should have had treated in their GP’s office. Phoenix has a large population of working poor and unemployed, many of whom live, shall we say, very close to the bone. And in those days, if you didn’t have insurance, you couldn’t even get in to see most doctors. Many people did not have a GP and never saw doctors for routine care.

An ER, on the other hand, is not allowed to turn you away. So, when someone without insurance or cash needed to see a doctor for a minor ailment, they would go to the ER and sit there until they could finally get in. This meant waits for everyone that extended for many hours.

It was Christmas time. A flu epidemic was raging. And conveniently, my body chose that moment to develop appendicitis.

In terrible pain and throwing up, I persuaded my ex-husband to take me to the ER at St Joseph’s, a large regional medical center in the central part of the city. It was late at night.

The ER was packed. The receptionist, overworked and miserable, was rude to me and gave me a dirty look when I threw up into the bucket I’d brought.

There was no place to sit down. The floor was truly filthy, so I didn’t feel I could sit or lay down on the floor. Three hours later, I found myself sitting outside on a concrete bench, in the cold, next to a woman who was miscarrying and who had been waiting over four hours. We waited another couple of hours without anyone caring whether we lived or died.

Finally, I gave up. I figured if I was going to die, I’d rather die at home in my bed than in that place. I called a friend, waking her out of a sound sleep, and persuaded her to come get me.

At dawn I was in agony. I called the Mayo Clinic, where my old doctor was practicing. They told me to call 911 and have them bring me there. I said I thought they would take me back to St. Joe’s and I couldn’t withstand another fruitless, endless wait. She said no, they have to take you where you ask them to take you.

That, as it developed, was wrong. They would not take me to the Mayo — the twenty-minute drive would take them out of their area. I sent them away and called another friend, who kindly drove me to the Mayo.

The Mayo, being in a more upscale part of town, was not crowded with people who couldn’t afford to see a doctor. Within minutes after I walked in, they were rolling me into surgery. In the elderly, appendicitis may be life-threatening, especially if it goes  untreated. Afterwards, the surgeons said the appendix was “a mess,” one of the worst they’d seen.

On the one hand, my feeling is that you wouldn’t go to the ER if you didn’t have an emergency. Obviously, I needed to be seen in less than four hours, and obviously the young woman I took up with on the bench in the winter cold needed to be seen. Obviously, we needed to be seen when I came in.

On the other, I surely understand that when everybody and his little brother and sister use the ER for routine medical care and show up when they have a bad cold or flu, the staff is overwhelmed and the likelihood that they will fail to recognize a true emergency is high. I also understand that an inner-city ER staff sees not only the routine heart attacks, strokes, accident, and appendicitis cases, but a steady flow of knifings, gunshot wounds, car wreck victims, and drug overdoses, and so of course they do not have time to deal with people’s colds and tummyaches.

With the ACA, this problem was somewhat relieved because more poor people could get insured. Once that goes away, though, we can expect to see those conditions to return. When people can’t get insurance and doctors turn the poor away because they’re uninsured and can’t pay, then ERs will fill up again with folks who need routine medical care. And the next time you have a serious condition that really does need immediate attention, you may not be able to get it.

Images:
Section of acutely inflamed appendix: By Ed Uthman from Houston, TX, USA – Acute Appendicitis, CC BY 2.0
Banner image of the day: DepositPhotos, © sepavone

Or maybe that’s “Standard Operating Overkill”? Have you seen this eye-opener from ProPublica, “When Evidence Says No, But Doctors Say Yes“? You need to read it.

In very brief summary, the report shows — through surveys of published, peer-reviewed scientific studies — that much of the most commonly prescribed medical treatments and the most commonly performed procedures are unnecessary and unhelpful. Further, the reporters find, many doctors know this and ignore it, because the profitability of these treatments drives profitability of their own practices, and many more well-meaning doctors do not know it because they’re so busy they haven’t found time to read the research.

For example, an American study revealed:

Some of the contradicted practices possibly affect millions of people daily: Intensive medication to keep blood pressure very low in diabetic patients caused more side effects and was no better at preventing heart attacks or death than more mild treatments that allowed for a somewhat higher blood pressure. Other practices challenged by the study are less common — like the use of a genetic test to determine if a popular blood thinner is right for a particular patient — but gaining in popularity despite mounting contrary evidence. Some examples defy intuition: CPR is no more effective with rescue breathing than if chest compressions are used alone; and breast-cancer survivors who are told not to lift weights with swollen limbs actually should lift weights, because it improves their symptoms.

Australian researchers, in a government-funded study there, identified “156 active medical practices that are probably unsafe or ineffective.”

Many of these involve procedures that are presented to doctors and to patients as indispensably life-saving: stents in stable heart patients have been shown to prevent no heart attacks and to save no lives. That’s correct: zero (0). Beta blockers as treatment for high blood pressure turn out to have little effect on stroke and do not significantly reduce mortality or coronary heart disease. Indeed, one such drug, atenolol, resulted in greater frequency of stroke.

Knee surgery for a torn meniscus is routinely performed on countless people who experience little or no benefit from the procedure.

It’s a wide-ranging article, and I can’t regurgitate it all here. You really need to look at it. Especially have a look at the chart that, by way of explaining what the relative numbers of people who are helped, not helped, and harmed, shows in eye-popping clarity the efficacy and relative risk of swallowing a sleep aid. It’s about 3/4 of the way through the article.

Y’know, the women on my mother’s side of the family — ones who grew up in the late 1800s, when medicine was more risk than benefit — were Christian Scientists. My mother and I thought they were crazy (and truly there’s no escaping Mary Baker Eddy’s looniness!). But sometimes one wonders.

My great-grandmother and my great-aunt both lived into their mid-90s, and they never saw a doctor. Never took pills, never had surgical procedures. They were both active and healthy right up to their last days.

Like Mormons, they didn’t drink alcohol or caffeine. They did not smoke. They ate exceptionally well: whole foods with lots of fresh vegetable, fruits, and meats, cooked at home by my great-grandmother, who was supported by my great-aunt. They lived in Berkeley, about halfway down a hill. At the top of this hill, next to the tunnel through which the commuter train to San Francisco passed, was a neighborhood grocery store.

Two or three times a week, my great-grandmother would walk up to this store, dragging what we call a “granny cart” behind her. She would fill it with groceries and roll it back down the hill. She did all the housework, which in those days entailed some pretty vigorous scrubbing. She hung the laundry on a line in the backyard, and she did all the ironing.

Every morning, five days a week, my great-aunt walked up the same hill, caught the train into San Francisco, got out at the station, and walked across town to the bank where she worked.

So…what we have here are a) temperance, b) regular mild exercise; c) whole foods. And d) no pills, no drugs, no procedures, no doctors.

One could argue that d) follows naturally from a), b), and c)…but of course we do know that people get hurt and that any number of ailments may afflict us no matter how righteous we are. My grandmother died of uterine cancer; she delayed going to a doctor until she could stand it no longer, at which point the man told her (vindictively, IMHO) that if he’d seen her three months earlier he could have saved her life.

On the other hand…my grandmother was a wild hare: she indeed did smoke and drink, and she was (from what I’m told) sexually promiscuous. On her deathbed, she told my mother that she believed the agony she was going through was God’s punishment for all the abortions she’d had.

So…well…maybe not God. But yeah…maybe risky behavior hath its rewards. As it were.

The point here is that you need to be careful about what treatments doctors foist on you. Do your research. When a doctor says you have this or that ailment and you must swallow this or that drug or subject yourself to this or that test or surgery, find out for sure whether that’s true. Learn the right questions to ask, and learn what the answers actually mean. And always get a second opinion.

And clean up your act. As the ProPublica report notes:

The health problems that most commonly afflict the American public are largely driven by lifestyle habits—smoking, poor nutrition, and lack of physical activity, among others. In November, a team led by researchers at Massachusetts General Hospital pooled data from tens of thousands of people in four separate health studies from 1987 to 2008. They found that simple, moderate lifestyle changes dramatically reduced the risk of heart disease, the most prolific killer in the country, responsible for one in every four deaths. People deemed at high familial risk of heart disease cut their risk in half if they satisfied three of the following four criteria: didn’t smoke (even if they smoked in the past); weren’t obese (although they could be overweight); exercised once a week; ate more real food and less processed food. Fitting even two of those categories still substantially decreased risk. In August, a report issued by the International Agency for Research on Cancer concluded that obesity is now linked to an extraordinary variety of cancers, from thyroids and ovaries to livers and colons. [My emphasis.]

Ahem. And so, away…it’s off to pump up the bicycle tires and cruise the ‘hood.